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1.
Adv Radiat Oncol ; 6(6): 100725, 2021.
Article in English | MEDLINE | ID: covidwho-1432710

ABSTRACT

PURPOSE: To report real-world compliance to radiation in gynecologic cancers during the complete lockdown phase of COVID-19 pandemic. METHODS AND MATERIALS: From March 23, 2020, until June 30, 2020, complete lockdown was imposed in India. During this period there was restructuring of cancer care and radiation oncology department due to operational policies prevalent in the institution, and the care for gynecological cancer was based on the evolving international recommendations. Institutional review board approval was obtained to audit patterns of care during the complete lockdown phase. Descriptive variables were used to report on patient characteristics, compliance, delays, toxicity, and observed deviations in recommended care. RESULTS: During the lockdown period spanning 100 days, treatment of 270 and telephonic follow-up of 1103 patients with gynecological cancer was undertaken. Of 270 new patients, due to travel restrictions, 90 patients were referred to the facilities in vicinity of their residence. Of the remaining 180 patients, 138 were planned for complete treatment at our institution and 42 were referred to our center for brachytherapy. Of 138 patients, only 106 (76%) completed the planned external radiation. Twenty-four (26%) patients completed full course of concurrent chemotherapy, 11 (12%) received chemotherapy dose reduction, and 57 (62%) received no concurrent chemotherapy. Treatment delay of up to 3 weeks was noted in 8.6% patients due to COVID-19 infection. No grade 4 to 5 acute sequelae were observed. No excess adverse effects were observed in high-risk population. Low rate of symptom burden was observed among 1103 patients on telephonic follow-up. With 100 (9.6%) patients reporting symptoms, among these, 54% (54 of 100) had complete resolution of symptoms within 4 weeks of teleconsultation, and 10% had disease progression. CONCLUSIONS: Low compliance with planned treatment was observed for radiation and concurrent chemotherapy due to lockdown and fear of contracting COVID-19 and will likely lead to increased risk of cancer-related mortality. Rapid restructuring of care is needed to prevent the same as COVID-19 pandemic further evolves.

2.
Am J Clin Oncol ; 44(8): 409-412, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1262256

ABSTRACT

OBJECTIVES: Current coronavirus disease 2019 (COVID-19) guidelines recommend delaying clinical care for all affected cancer patients, including incidentally diagnosed asymptomatic infections. This retrospective study conducted in a safety-net hospital in Houston examines the care delivery of asymptomatic COVID-19 cancer patients and how their diagnosis affected their care. METHODS: A retrospective chart review was conducted on cancer patients with a documented positive SARS-CoV-2 laboratory result in the Harris Health System in Houston, Texas. Patient demographics, treatment delays, and patient outcomes were analyzed. RESULTS: Thirteen percent (n=24) of all patients with cancer and COVID-19 diagnosis (n=181) were asymptomatic and 96% had a solid organ malignancy. Among asymptomatic patients, 44% (n=11) of them experienced a median treatment delay of 33 days and 21% (n=5) transitioned to hospice. No patients had progression of disease at first evaluation after recovering from COVID-19 diagnosis. Asymptomatic patients were more likely to have a worse ECOG performance status, metastatic disease, and charity insurance as compared with symptomatic patients. CONCLUSIONS: This study supports the safety of our current isolation guidelines for all COVID-19 asymptomatic cancer patients. While treatment delays occurred, they did not appear to significantly impact overall care. Differences in care delivery and health care usage patterns between symptomatic and asymptomatic patients demonstrate the need for continued studies in vulnerable populations.


Subject(s)
COVID-19/etiology , Delivery of Health Care/methods , Neoplasms/therapy , Neoplasms/virology , Adult , Aged , Aged, 80 and over , Asymptomatic Infections/epidemiology , COVID-19/epidemiology , COVID-19 Testing , Delivery of Health Care/organization & administration , Female , Humans , Male , Middle Aged , Patient Safety , Safety-net Providers , Tertiary Care Centers , Texas/epidemiology , Time-to-Treatment
3.
J Natl Compr Canc Netw ; 19(9): 1063-1071, 2021 05 28.
Article in English | MEDLINE | ID: covidwho-1256975

ABSTRACT

BACKGROUND: Delays in diagnosis and treatment have been reported for many cancers, with resultant stage migration and worse survival; however, few data exist in patients with hepatocellular carcinoma (HCC). These data are of particular importance in light of the COVID-19 pandemic, which has caused disruptions in healthcare processes and may continue to impact cancer care for the foreseeable future. The aim of our study was to characterize the prevalence and clinical significance of diagnostic and treatment delays in patients with HCC. METHODS: We performed a retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and July 2017 at 2 US health systems. Diagnostic and treatment delays were defined as >90 days between presentation and HCC diagnosis and between diagnosis and treatment, respectively. We used multivariable logistic regression to identify factors associated with diagnostic and treatment delays and Cox proportional hazard models to identify correlates of overall survival. RESULTS: Of 925 patients with HCC, 39.0% were diagnosed via screening, 33.1% incidentally, and 27.9% symptomatically. Median time from presentation to diagnosis was 37 days (interquartile range, 18-94 days), with 120 patients (13.0%) experiencing diagnostic delays. Median time from HCC diagnosis to treatment was 46 days (interquartile range, 29-74 days), with 17.2% of patients experiencing treatment delays. Most (72.5%) diagnostic delays were related to provider-level factors (eg, monitoring indeterminate nodules), whereas nearly half (46.2%) of treatment delays were related to patient-related factors (eg, missed appointments). In multivariable analyses, treatment delays were not associated with increased mortality (hazard ratio, 0.90; 95% CI, 0.60-1.35); these results were consistent across subgroup analyses by Barcelona Clinic Liver Cancer stage and treatment modality. CONCLUSIONS: Diagnostic and therapeutic delays exceeding 3 months are common in patients with HCC; however, observed treatment delays do not seem to significantly impact overall survival.


Subject(s)
COVID-19 , Carcinoma, Hepatocellular , Liver Neoplasms , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/therapy , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/epidemiology , Liver Neoplasms/therapy , Pandemics , Retrospective Studies , SARS-CoV-2
4.
Cancer Rep (Hoboken) ; 5(2): e1426, 2022 02.
Article in English | MEDLINE | ID: covidwho-1237412

ABSTRACT

BACKGROUND: Cancer care during the Covid-19 pandemic has been challenging especially in a developing country such as the Philippines. Oncologists were advised to prioritize chemotherapy based on the absolute benefit that the patient may receive, which outbalances the risks of Covid-19 infection. The results of this study will allow re-examination of how to approach cancer care during the pandemic and ultimately, help optimize treatment recommendations during this crisis. AIM: This study described the factors contributing to treatment delays during the pandemic and their impact on disease progression. MATERIALS AND RESULTS: This retrospective cohort study was done in St. Luke's Medical Center, a private tertiary healthcare institution based in Metro Manila, Philippines, composed of two facilities in Quezon City and Global City. Patients with solid malignancy with ongoing systemic cancer treatment prior to the peak of the pandemic were identified. Clinical characteristics and treatment data were compared between those with delayed and continued treatments. Multivariate analysis was done to determine factors for treatment delays and association of delays with disease progression and Covid-19 infection. Of the 111 patients, 33% experienced treatment delays and 67% continued treatment during the pandemic. There was a higher percentage of patients on palliative intent who underwent treatment delay, and 64% of delays were due to logistic difficulties. Treatment delays were significantly associated with disease progression (p < .0001). There was no evidence of association between delay or continuation of treatment and risk of Covid-19 infection. CONCLUSIONS: There was no difference in Covid-19 infection between those who delayed and continued treatment during the pandemic; however, treatment delays were associated with a higher incidence of disease progression. Our findings suggest that the risks of cancer progression due to treatment delays exceed the risks of Covid-19 infection in cancer patients implying that beneficial treatment should not be delayed as much as possible. Logistic hindrances were also identified as the most common cause of treatment delay among Filipino patients, suggesting that efforts should be focused into assistance programs that will mitigate these barriers to ensure continuity of cancer care services during the pandemic.


Subject(s)
Antineoplastic Agents/therapeutic use , COVID-19/epidemiology , Neoplasms/drug therapy , Time-to-Treatment/statistics & numerical data , Adult , Aged , COVID-19/immunology , COVID-19/prevention & control , COVID-19/transmission , Cancer Care Facilities/organization & administration , Cancer Care Facilities/standards , Cancer Care Facilities/statistics & numerical data , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Disease Progression , Female , Humans , Male , Middle Aged , Neoplasm Staging , Neoplasms/complications , Neoplasms/diagnosis , Neoplasms/immunology , Pandemics/prevention & control , Philippines/epidemiology , Retrospective Studies , Risk Factors , Treatment Outcome , Young Adult
5.
Front Cardiovasc Med ; 8: 645135, 2021.
Article in English | MEDLINE | ID: covidwho-1231326

ABSTRACT

Background: The COVID-19 (coronavirus disease 2019) pandemic is reducing health care accessibility to non-life-threatening diseases, thus hiding their real incidence. Moreover, the incidence of potentially fatal conditions such as acute type A aortic dissection seems to have decreased since the pandemic began, whereas the number of cases of chronic ascending aortic dissections dramatically increased. We present two patients whose management has been affected by the exceptional sanitary situation we are dealing with. Case report: A 70-year-old man with chest pain and an aortic regurgitation murmur had his cardiac workup delayed (4 months) because of sanitary restrictions. He was then diagnosed with chronic type A aortic dissection and underwent urgent replacement of ascending aorta and aortic root. The delay in surgical treatment made the intervention technically challenging because the ascending aorta grew up to 80 mm inducing strong adhesions and chronic inflammation. The second case report concerns a 68-year-old woman with right lower-limb pain who was diagnosed with deep vein thrombosis. However, a CT scan to exclude a pulmonary embolism could not be realized until 5 months later because of sanitary restrictions. When she eventually got the CT scan, it fortuitously showed a chronic dissection of the ascending aorta. She underwent urgent surgery, and the intervention was challenging because of adhesions and severe inflammation. Conclusion: Delayed treatment due to sanitary restrictions related to COVID-19 pandemic is having a significant impact on the management of potentially life-threatening conditions including type A aortic dissection. We should remain careful to avoid COVID-19 also hitting patients who are not infected with the virus.

6.
Int Med Case Rep J ; 14: 205-210, 2021.
Article in English | MEDLINE | ID: covidwho-1175486

ABSTRACT

INTRODUCTION: Ophthalmic trauma is defined as injuries affecting the ocular structures, including the globe, eyelid, lacrimal system, and surrounding orbital walls. Blunt trauma acts as the leading cause of injury and it may affect both the anterior and posterior parts of the globe. Prompt diagnosis, early management, and sustained follow-up are mandatory for an optimal outcome. PURPOSE: This report presents a one-step surgery management process for an intricate case of blunt facial trauma with complex ophthalmic and nasal injury. PATIENTS AND METHODS: A 45-year-old male with blunt force trauma of the left eye from a wooden block, suffered from naso-orbital-ethmoidal fractures, eyelid laceration with canalicular, close-globe injuries of traumatic cataract and vitreous hemorrhage with retinal detachment. A simultaneous one-step surgery was performed by a trauma team of ophthalmological and ENT surgeons during the height of the COVID-19 pandemic to lessen the risk of cross-transmission. After ruling out the possibility of open-globe rupture, traumatic cataract extraction, retinal detachment surgery, the repair of an eyelid laceration with canalicular involvement, and septorhinoplasty were performed on concomitantly. RESULTS: Anatomical success was achieved for the repair of the nasoorbitoethmoidal (NOE) type II fracture and close-globe injuries, including the anatomical reattachment of the retina. However, the functional outcome remained unsatisfactory. Visual acuity failed to show further improvement at a later follow-up. Traumatic optic neuropathy was, at the final follow-up, considered to be the cause of the suboptimal visual acuity. CONCLUSION: A single-step multi-procedure for a complex ophthalmic blunt trauma, as demonstrated in this case, may be beneficial for reducing the complications that might arise due to treatment delay. The complex nature of the injury, however, creates the higher possibility for residual post-operative complications. Risks of residual functional impairment should be considered in such complex trauma prior to surgery, to determine the surgical prognostic value and provide appropriate consent to the patient.

7.
J Psychosoc Oncol ; 39(3): 416-427, 2021.
Article in English | MEDLINE | ID: covidwho-1165099

ABSTRACT

BACKGROUND: The novel coronavirus (COVID-19) rapidly shifted psychosocial services to telepsychology, including psychosocial oncology (PSO) practices. PSO providers work with patients undergoing treatment, experiencing treatment delays and/or immuno-suppression in the context of a global pandemic. There is evidence to support the acceptability of telepsychology among cancer patients and an emerging need for data to inform the design and provision of telepsychology PSO care during the pandemic and beyond. RESEARCH OBJECTIVES: This study examined engagement in telepsychology PSO care at an outpatient community cancer center. METHODS: The current study analyzed practice data from a PSO department from March 2020 through September 2020. The sample included 354 patients (91 established; 263 newly referred). Descriptive, correlational, and comparative analyses were conducted. RESULTS: Among established patients, 93% continued with telepsychology PSO care after the pandemic and 94% completed at least one telepsychology appointment. Among newly referred patients, 50.6% scheduled a telepsychology appointment, consistent with the scheduling rate for the proceeding calendar year (50%). Across patients scheduling telepsychology PSO appointments (N = 194), 68 initially engaged in phone-based services with 20 converting to video, for a total of 127 (76.5%) patients utilizing video-based PSO services. Common reasons for phone-based services included 'patient preference' (N = 14), 'lack of access' (N = 9), and 'technology barriers' (N = 8). During this timeframe, 18% had at least one no-show, which is significantly less than the preceding year (23%). Phone-based patients were significantly older (p =.007). A greater proportion of males engaged in phone-based services compared to females (p = .006). CONCLUSIONS: Telepsychology PSO engages new and existing patients during the COVID-19 pandemic. There may be an increased demand for services and increased utilization in the context of the pandemic and the availability of telepsychology. There are disparities and access issues that should be considered and addressed.


Subject(s)
COVID-19 , Facilities and Services Utilization/statistics & numerical data , Neoplasms/psychology , Neoplasms/rehabilitation , Psychosocial Intervention/statistics & numerical data , Telemedicine/statistics & numerical data , Ambulatory Care/statistics & numerical data , Community Health Services/statistics & numerical data , Female , Humans , Internet-Based Intervention/statistics & numerical data , Male , Middle Aged , Psycho-Oncology/statistics & numerical data , Referral and Consultation/statistics & numerical data , Retrospective Studies , Telephone/statistics & numerical data
8.
BJU Int ; 127(6): 729-741, 2021 06.
Article in English | MEDLINE | ID: covidwho-1138102

ABSTRACT

OBJECTIVE: Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic. METHODS: We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways. RESULTS: Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites. CONCLUSION: Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.


Subject(s)
COVID-19/epidemiology , Critical Pathways , Pandemics , Prostatectomy , Prostatic Neoplasms/surgery , Delphi Technique , Health Care Rationing , Humans , Infection Control , Male , SARS-CoV-2 , Time-to-Treatment
9.
J Natl Med Assoc ; 113(4): 436-439, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1129083

ABSTRACT

The COVID-19 pandemic reminds us that African American, Latinx, Indigenous, and poor communities face significant healthcare disparities. Members of these communities have increased exposure to the virus due to higher rates of crowded living conditions and employment in essential occupations. Furthermore, news reports and public health data show that residents of these communities have more comorbidities, utilize hospitals with fewer resources, and experience greater treatment delays, all resulting in higher mortality related to COVID-19. The same social determinants contributing to the inequities seen in COVID-19 drive similar disparities in oncology. Oncologic inequities have long predated the inequities associated with COVID-19 and have led to considerably more deaths. These stark realities demand that we stop merely reporting the impact of adverse social determinants on the health of communities. We must instead target these causes of healthcare disparities. Here, we discuss proposed action items from the 2019 National Cancer Policy Forum workshop entitled "Applying Big Data to Address the Social Determinants of Health in Oncology." These actions are critical first steps to address adverse social determinants and thereby decrease unnecessary deaths in underserved communities.


Subject(s)
COVID-19 , Health Status Disparities , Healthcare Disparities , Neoplasms , Social Determinants of Health , African Americans , Big Data , Health Policy , Humans , Pandemics , Public Health
10.
Risk Manag Healthc Policy ; 14: 895-900, 2021.
Article in English | MEDLINE | ID: covidwho-1127893

ABSTRACT

PURPOSE: In the background of the global pandemic, we aim to investigate the effect of COVID-19 on diagnosis and treatment delay in urology patients. PATIENTS AND METHODS: A total of 4919 inpatients were identified from the urological department in our institution, including 2947 and 1972 patients within 9 months before and after the outbreak (group A and group B). The baseline characteristics and residential population of different types of diseases were compared in the two groups. Patients who underwent delay of diagnosis or treatment with poor outcomes were described. RESULTS: Our result revealed a 33.1% decrease of total resident population as well as a 44.8% decline in bed utilization rate after the outbreak. Significant differences were found between group A and group B in gender (P=0.024) and patients living alone or not (P=0.026). The hospitalization rate of patients with malignancy increased significantly while that of benign patients decreased during the epidemic (P<0.001). Besides, we identified 5 cases with bladder cancer and 3 cases with prostate cancer that underwent delay of diagnosis or treatment with unfavorable consequences. CONCLUSION: With the impact of COVID-19, delay in diagnosis or treatment of non-COVID-19 diseases is inevitable whether the medical resources allocation is effective or not. Psychological status of patients might be the major cause of postponing diagnosis or treatment. For urological patients with locally advanced tumor or rapid progression, who need long-term postoperative intervention, the delay of regular treatment could lead to inevitable progression or recurrence.

11.
Qual Life Res ; 30(7): 1903-1912, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1103503

ABSTRACT

PURPOSE: Pandemics can be associated with anxiety and depression in cancer patients who are undergoing treatment. In the present study, we aimed to perform a comparative evaluation of the conditions of cancer patients before and during the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to detect the impact of the pandemic on treatment delays that are associated with anxiety and depression in cancer patients. In addition, the effect of public transport use on treatment delays was examined. METHODS: BDI and BAI were administered to 595 breast, ovarian, colon and gastric cancer patients before and during the pandemic. The questionnaires were administered by the physician blindly, who was unaware of the delay of the patients. The number of days by which the patients delayed their treatment due to the fear of contamination were recorded retrospectively. Correlation analyses were performed between the obtained scores and treatment delays. RESULTS: The depression and anxiety levels in cancer patients were found to increase during the pandemic (p = 0.000), and this increase was positively correlated with the disruption of their treatment (p = 0.000, r = 0.81). Depression and anxiety levels and treatment delays were higher in elderly patients (p = 0.021). Depression and anxiety were more pronounced in female patients (p = 0.000). Moreover, treatment delays were more common in patients who had to use public transportation (p = 0.038). CONCLUSION: SARS-CoV-2 pandemic may increase anxiety and depression in cancer patients. This can cause patients to experience treatment delays due to concerns about becoming infected. At this point, if necessary, assistance should be obtained from psychiatric and public health experts.


Subject(s)
Anxiety/psychology , COVID-19/epidemiology , Depression/psychology , Neoplasms/psychology , Neoplasms/therapy , Time-to-Treatment , Aged , COVID-19/psychology , Female , Humans , Male , Pandemics , Quality of Life/psychology , Retrospective Studies , SARS-CoV-2/isolation & purification , Turkey/epidemiology
12.
JAMA Netw Open ; 4(1): e2034065, 2021 01 04.
Article in English | MEDLINE | ID: covidwho-1049541

ABSTRACT

Importance: The coronavirus disease 2019 (COVID-19) pandemic has led to treatment delays for many patients with cancer. While published guidelines provide suggestions on which cases are appropriate for treatment delay, there are no good quantitative estimates on the association of delays with tumor control or risk of new metastases. Objectives: To develop a simplified mathematical model of tumor growth, control, and new metastases for cancers with varying doubling times and metastatic potential and to estimate tumor control probability (TCP) and metastases risk as a function of treatment delay interval. Design, Setting, and Participants: This decision analytical model describes a quantitative model for 3 tumors (ie, head and neck, colorectal, and non-small cell lung cancers). Using accepted ranges of tumor doubling times and metastatic development from the clinical literature from 2001 to 2020, estimates of tumor growth, TCP, and new metastases were analyzed for various treatment delay intervals. Main Outcomes and Measures: Risk estimates for potential decreases in local TCP and increases in new metastases with each interval of treatment delay. Results: For fast-growing head and neck tumors with a 2-month treatment delay, there was an estimated 4.8% (95% CI, 3.4%-6.4%) increase in local tumor control risk and a 0.49% (0.47%-0.51%) increase in new distal metastases risk. A 6-month delay was associated with an estimated 21.3% (13.4-30.4) increase in local tumor control risk and a 6.0% (5.2-6.8) increase in distal metastases risk. For intermediate-growing colorectal tumors, there was a 2.1% (0.7%-3.5%) increase in local tumor control risk and a 2.7% (2.6%-2.8%) increase in distal metastases risk at 2 months and a 7.6% (2.2%-14.2%) increase in local tumor control risk and a 24.7% (21.9%-27.8%) increase in distal metastases risk at 6 months. For slower-growing lung tumors, there was a 1.2% (0.0%-2.8%) increase in local tumor control risk and a 0.19% (0.18%-0.20%) increase in distal metastases risk at 2 months, and a 4.3% (0.0%-10.6%) increase in local tumor control risk and a 1.9% (1.6%-2.2%) increase in distal metastases risk at 6 months. Conclusions and Relevance: This study proposed a model to quantify the association of treatment delays with local tumor control and risk of new metastases. The detrimental associations were greatest for tumors with faster rates of proliferation and metastasis. The associations were smaller, but still substantial, for slower-growing tumors.


Subject(s)
Decision Support Techniques , Models, Theoretical , Neoplasm Metastasis/diagnosis , Neoplasms/diagnosis , Time-to-Treatment/statistics & numerical data , COVID-19 , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/therapy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/therapy , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/therapy , Humans , Neoplasms/therapy , Risk Assessment , SARS-CoV-2
14.
Anatol J Cardiol ; 24(5): 334-342, 2020 11.
Article in English | MEDLINE | ID: covidwho-895744

ABSTRACT

OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).


Subject(s)
Coronavirus Infections/epidemiology , Myocardial Infarction/therapy , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Time-to-Treatment/statistics & numerical data , Aged , COVID-19 , Coronary Angiography/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Female , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Percutaneous Coronary Intervention/statistics & numerical data , Prognosis , Registries , Regression Analysis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Shock, Cardiogenic/etiology , Shock, Cardiogenic/mortality , Time Factors , Treatment Outcome , Turkey/epidemiology
15.
JAMA Oncol ; 6(12): 1881-1889, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-893187

ABSTRACT

Importance: Cancer treatment delay has been reported to variably impact cancer-specific survival and coronavirus disease 2019 (COVID-19)-specific mortality during the severe acute respiratory syndrome coronavirus 2 pandemic. During the pandemic, treatment delay is being recommended in a nonquantitative, nonobjective, and nonpersonalized manner, and this approach may be associated with suboptimal outcomes. Quantitative integration of cancer mortality estimates and data on the consequences of treatment delay is needed to aid treatment decisions and improve patient outcomes. Objective: To obtain quantitative integration of cancer-specific and COVID-19-specific mortality estimates that can be used to make optimal decisions for individual patients and optimize resource allocation. Design, Setting, and Participants: In this decision analytical model, age-specific and stage-specific estimates of overall survival pre-COVID-19 were adjusted by the probability of COVID-19 (individualized by county, treatment-specific variables, hospital exposure frequency, and COVID-19 infectivity estimates), COVID-19 mortality (individualized by age-specific, comorbidity-specific, and treatment-specific variables), and delay of cancer treatment (impact and duration). These model estimates were integrated into a web application (OncCOVID) to calculate estimates of the cumulative overall survival and restricted mean survival time of patients who received immediate vs delayed cancer treatment. Using currently available information about COVID-19, a susceptible-infected-recovered model that accounted for the increased risk among patients at health care treatment centers was developed. This model integrated the data on cancer mortality and the consequences of treatment delay to aid treatment decisions. Age-specific and cancer stage-specific estimates of overall survival pre-COVID-19 were extracted from the Surveillance, Epidemiology, and End Results database for 691 854 individuals with 25 cancer types who received cancer diagnoses in 2005 to 2006. Data from 5 436 896 individuals in the National Cancer Database were used to estimate the independent impact of treatment delay by cancer type and stage. In addition, data from 275 patients in a nested case-control study were used to estimate the COVID-19 mortality rate by age group and number of comorbidities. Data were analyzed from March 17 to May 21, 2020. Exposures: COVID-19 and cancer. Main Outcomes and Measures: Estimates of restricted mean survival time after the receipt of immediate vs delayed cancer treatment. Results: At the time of the study, the OncCOVID web application allowed for the selection of up to 47 individualized variables to assess net survival for an individual patient with cancer. Substantial heterogeneity was found regarding the association between delayed cancer treatment and net survival among patients with a given cancer type and stage, and these 2 variables were insufficient to discriminate the net impact of immediate vs delayed treatment. Individualized overall survival estimates were associated with patient age, number of comorbidities, treatment received, and specific local community estimates of COVID-19 risk. Conclusions and Relevance: This decision analytical modeling study found that the OncCOVID web-based application can quantitatively aid in the resource allocation of individualized treatment for patients with cancer during the COVID-19 global pandemic.


Subject(s)
COVID-19/prevention & control , Neoplasms/therapy , Outcome Assessment, Health Care/statistics & numerical data , SEER Program/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Female , Humans , Male , Middle Aged , Neoplasms/epidemiology , Outcome Assessment, Health Care/methods , Pandemics , SARS-CoV-2/physiology , Survival Analysis , Survival Rate , Time-to-Treatment , United States/epidemiology
17.
Urol Oncol ; 39(5): 258-267, 2021 05.
Article in English | MEDLINE | ID: covidwho-894253

ABSTRACT

The COVID-19 pandemic-related constraints on healthcare access have raised concerns about adverse outcomes from delayed treatment, including the risk of cancer progression and other complications. Further, concerns were raised about a potentially significant backlog of patients in need of cancer care due to the pandemic-related delays in healthcare, further exacerbating any potential adverse outcomes. Delayed access to surgery is particularly relevant to urologic oncology since one-third of new cancers in men (20% overall) arise from the genitourinary (GU) tract and surgery is often the primary treatment. Herein, we summarize the prepandemic literature on deferred surgery for GU cancers and risk of disease progression. The aforementioned data on delayed surgery were gathered in the context of systemic delays present in certain healthcare systems, or occasionally, due to planned deferral in suboptimal surgical candidates. These data provide indirect, but sufficient insight to develop triage schemas for prioritization of uro-oncological cases. Herein, we outline the extent to which the pandemic-related triage guidelines had influenced urologic practice in various regions. To study the adverse outcomes in the pandemic-era, a survey of urologic oncologists was conducted regarding modifications in their initial management of urologic cancers and any delay-related adverse outcomes. While the adverse effects directly from COVID-19 related delays will become apparent in the coming years, the results showing short-term outcomes are quite instructive. Since cancer care was assigned a higher priority at most centers, this strategy may have avoided significant delays in care and limited the anticipated negative impact of pandemic-related constraints.


Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , SARS-CoV-2/isolation & purification , Urogenital Neoplasms/surgery , Urologic Neoplasms/surgery , Urologic Surgical Procedures/methods , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Humans , Male , Medical Oncology/statistics & numerical data , Middle Aged , Neoplasm Staging , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Pandemics , Penile Neoplasms/pathology , Penile Neoplasms/surgery , SARS-CoV-2/physiology , Testicular Neoplasms/pathology , Testicular Neoplasms/surgery , Time-to-Treatment , Urogenital Neoplasms/pathology , Urologic Neoplasms/pathology
18.
Neurooncol Adv ; 2(1): vdaa104, 2020.
Article in English | MEDLINE | ID: covidwho-807136

ABSTRACT

BACKGROUND: Since the COVID-19 pandemic began, thousands of medical procedures and appointments have been canceled or delayed. The long-term effects of these drastic measures on brain tumor patients and caregivers are unknown. The purpose of this study is to better understand how COVID-19 has affected this vulnerable population on a global scale. METHODS: An online 79-question survey was developed by the International Brain Tumour Alliance, in conjunction with the SNO COVID-19 Task Force. The survey was sent to more than 120 brain tumor charities and not-for-profits worldwide and disseminated to pediatric and adult brain tumor patients and caregivers. Responses were collected from April to May 2020 and subdivided by patient versus caregiver and by geographical region. RESULTS: In total, 1989 participants completed the survey from 33 countries, including 1459 patients and 530 caregivers. There were no significant differences in COVID-19 testing rates (P = .662) or positive cases for brain tumor patients between regions (P = .1068). Caregivers were significantly more anxious than patients (P ≤ .0001). Patients from the Americas were most likely to have lost their jobs due to the pandemic, practiced self-isolation, and received telehealth services (P ≤ .0001). Patients from Europe experienced the most treatment delays (P = .0031). Healthcare providers, brain tumor charities, and not-for-profits were ranked as the most trusted sources of information. CONCLUSIONS: As a result of COVID-19, brain tumor patients and caregivers have experienced significant stress and anxiety. We must continue to provide accessible high-quality care, information, and support in the age of COVID-19.

19.
Gynecol Oncol ; 159(2): 470-475, 2020 11.
Article in English | MEDLINE | ID: covidwho-801306

ABSTRACT

BACKGROUND: New York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. METHODS: A prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. RESULTS: Among 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. CONCLUSIONS: More than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.


Subject(s)
Appointments and Schedules , Coronavirus Infections/epidemiology , Genital Neoplasms, Female/therapy , Hospitals/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Electronic Health Records , Female , Humans , Middle Aged , New York City/epidemiology , Pneumonia, Viral/diagnosis , Registries , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data
20.
Thorac Cancer ; 11(10): 2983-2986, 2020 10.
Article in English | MEDLINE | ID: covidwho-713354

ABSTRACT

The current coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on the mental and physical health of patients, regional healthcare resources, and global economic activity. Many patients with lung cancer are thought to be affected by this situation. Therefore, in this study, we aimed to evaluate the impact of COVID-19 pandemic on lung cancer treatment scheduling. We retrospectively reviewed the medical records of lung cancer patients who were undergoing anticancer treatment at the National Hospital Organization Kyoto Medical Center (600 beds) in Kyoto, Japan, between 1 March 2020 and 31 May 2020. After the medical records were reviewed, the patients were assigned to one of two groups, depending on whether their lung cancer treatment schedule was delayed. We assessed the characteristics, types of histopathology and treatment, and the reason for the delay. A total 15 (9.1%) patients experienced a delay in lung cancer treatment during the COVID-19 pandemic. Patients with a treatment delay received significantly more immune checkpoint inhibitor (ICI) monotherapy than patients without a treatment delay (P = 0.0057). On the contrary, no patients receiving molecular targeted agents experienced a treatment delay during the COVID-19 pandemic period (P = 0.0027). The treatments of most of the patients were delayed at their request. We determined that 9.1% lung cancer patients suffered anxiety and requested a treatment delay during the COVID-19 pandemic. Oncologists should bear in mind that patients with cancer have more anxiety than expected under unprecedented circumstances such as the COVID-19 pandemic.


Subject(s)
Anxiety/psychology , Coronavirus Infections/psychology , Lung Neoplasms/psychology , Pneumonia, Viral/psychology , Time-to-Treatment , Aged , Aged, 80 and over , Anxiety/physiopathology , Betacoronavirus/pathogenicity , COVID-19 , Clinical Protocols , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Female , Health Services Research , Humans , Japan , Lung/physiopathology , Lung/virology , Lung Neoplasms/complications , Lung Neoplasms/physiopathology , Lung Neoplasms/virology , Male , Medical Records , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2
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