Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario.

INTRODUCTION: COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. METHODS: Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS: A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% versus -3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). CONCLUSIONS: Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

Role of meteorological factors in the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic in Italy.

OBJECTIVE: Understanding the evolutionary dynamics of the Coronavirus disease 2019 (COVID-19) pandemic in the coming months is a matter of great importance and urgency for governments worldwide, making fundamental decisions based on what is known about the transmission mechanisms of the virus and its survival in the environment. The present study aimed to evaluate the impact of demographic variables, solar radiation and relative humidity on the spread of the COVID-19 pandemic of the various regions in Italy. MATERIALS AND METHODS: The retrospective longitudinal study was conducted, and data used in this study was obtained from the Italian Health Ministry. Descriptive statistics included mean, frequency, and percentage, and results presented by graphs were calculated. RESULTS: The infection trend was investigated by comparing it with the demographic situation and the irradiation indices of solar ultraviolet light that are detected with the changing seasons. The present study reported that the geographic areas with higher population density and lower solar radiation during the autumn and winter months were most affected by SARS-CoV-2. CONCLUSIONS: The analysis carried out can provide a predictive model for the future phases of the COVID-19 pandemic in Italy, regardless of the adoption of lockdown measures and behavioral factors.

Mortality in patients requiring home mechanical ventilation during the COVID-19 pandemic: experiences of a regional specialist ventilation unit

P101 Figure 1(A) Monthly mortality of patients under Lane Fox Respiratory Service follow-up, dotted lines represent upper and lower bounds of 95% confidence intervals (B) Proportion of home mechanical ventilation (HMV) users in each disease category who died between 1st March and 30th ApriI by year[Figure omitted. See PDF]ConclusionsDeaths amongst HMV users at our regional ventilation centre were highest in the first two months following the onset of the COVID-19 pandemic. A subsequent fall in mortality may relate to effective shielding advice following national lockdown and departmental guidance offered. The majority of deaths were in patients with obesity-related respiratory failure. These data support previous observations that obesity is a major risk factor for adverse outcomes in patients with COVID-19.

Current challenges in COVID-19 diagnosis: A narrative review and implications for clinical practice

Early diagnosis of coronavirus disease 2019 (COVID-19) is crucial to early treatment and quarantine measures. In this narrative review, diagnostic tools for COVID-19 diagnosis and their main critical issues were reviewed. The COVID-19 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test is considered the gold standard test for the qualitative and quantitative detection of viral nucleic acid. In contrast, tests can be used for epidemiological surveys on specific communities, including occupational cohorts, but not for clinical diagnosis as a substitute for swab tests. Computed tomography (CT) scans can be useful for the clinical diagnosis of COVID-19, especially in symptomatic cases. The imaging features of COVID-19 are diverse and depend on the stage of infection after the onset of symptoms. CT sensitivity seems to be higher in patients with positive RT-PCR. Conventional chest sensitivity shows a lower sensitivity. An important diagnostic screening tool is ultrasounds, whose specificity and sensitivity depend on disease severity, patient weight, and operator skills. Nevertheless, ultrasounds could be useful as a screening tool in combination with clinical features and molecular testing to monitor disease progression. Clinical symptoms and non-specific laboratory findings may be useful if used in combination with RT-PCR test and CT-scanning.

Improve the conditions of lockdown may decrease anxiety among cancer patients during the COVID-19 pandemic

Background: The COVID-19 pandemic is a highly traumatic event that may lead to a greater risk of developing psychological disorders, especially in cancer patients who are more likely to be infected with the virus and to develop complications. The objective of this study was to measure anxiety levels among cancer patient during COVID-19 pandemic and the associated factors including patients’ conditions of lockdown. Methods: A cross-sectional study was conducted among adult cancer patients (hematological and solid tumors) receiving outpatient treatment or during follow-up in a French Comprehensive Cancer Centre. A postal self-administered questionnaire was sent to 4000 patients in June 2020, including Anxiety (Stait Trait), Fear of a cancer recurrence (FCR) as well as questions relative to socio-demographics, management of cancer care during the pandemic and the conditions of lockdown. Results: A total of 1097 patients completed the questionnaire (63.2% female;mean age 64.7 years ±12.3 years, 24.3% haematological cancers). Mean IES-R score was 15.7 ([0-81]) and 14.7% of patients had moderate or severe post-traumatic stress (score ≥33). Mean anxiety score was 39.0 (SD=13.6, range: [20-80]) with 30.5% of patients having anxiety symptoms. In the multivariate analysis we found that anxiety level was significantly increased for younger patients (OR=1.69, 95%IC [1.01-2.82]), female (OR=1.65, 95%IC [1.05-2.59]), patients with a high FCR score (OR=4.90, 95%IC [2.84-8.44]), patients unsatisfied with the current management of their cancer (OR=2.4, 95%IC [1.58-3.66]) and patients afraid of coming to hospital for fear of COVID (OR=2.10, 95%IC [1.32-3.35]). Protective factors against anxiety were staying busy during the lockdown period (OR=0.46, 95%IC [0.30-0.72]) and seeing the positive aspects of lockdown (OR=0.43, 95%IC [0.28-0.66]). Conclusions: These results contribute to a better understanding of the psychological consequences of COVID-19 pandemic in the context of cancer and highlight the need to better support patients at high risk of developing high anxiety levels. Conditions of lockdown are important to contain anxiety among cancer patients. Legal entity responsible for the study: Institut Paoli-Calmettes Marseille France. Funding: Janssen. Disclosure: G. Gravis Mescam: Financial Interests, Institutional, Advisory Board: BMS;Financial Interests, Institutional, Invited Speaker: Janssen;Financial Interests, Institutional, Advisory Board: Janssen;Financial Interests, Institutional, Advisory Board: Pfizer;Financial Interests, Institutional, Invited Speaker: Astellas;Financial Interests, Institutional, Invited Speaker: MSD;Financial Interests, Institutional, Invited Speaker: Astellas;Financial Interests, Institutional, Invited Speaker: Janssen;Financial Interests, Institutional, Advisory Board: Alliance Merck-Pfizer;Financial Interests, Institutional, Advisory Board: AAA;Financial Interests, Institutional, Invited Speaker: Astellas;Financial Interests, Institutional, Invited Speaker: Janssen;Financial Interests, Institutional, Invited Speaker: AMGEN;Financial Interests, Institutional, Invited Speaker: BMS;Financial Interests, Institutional, Advisory Board: Janssen;Financial Interests, Institutional, Invited Speaker: Sanofi;Financial Interests, Institutional, Funding: Janssen;Financial Interests, Institutional, Invited Speaker: BMS;Non-Financial Interests, Principal Investigator: Ipsen;Non-Financial Interests, Principal Investigator: BMS;Non-Financial Interests, Principal Investigator: Merck. All other authors have declared no conflicts of interest.

Immune thrombocytopenia and covid-19: A single centre experience

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by a platelet count <100×109/L without explanation. This laboratory parameter has emerged as an important complication and have been shown to correlate with severe course in the coronavirus disease (COVID-19) caused by novel coronavirus SARS-CoV-2. Aims: To analyze the clinical characteristics, diagnostic, blood count parameters, therapeutic strategies and outcomes in patients admitted with COVID-19 infection with acquired ITP. Methods: An observational, longitudinal, descriptive and retrospective study was performed on all patients who were COVID-19 positive and platelet count < 100×109/L admitted to hospital between March 1 2020 and January 31 2021 at our centre. All patients were laboratory confirmed COVID-19 positive with a positive nasopharyngeal swab. Clinical and demographic data were collected for each patient, including age, gender, nadir platelet count, bleeding symptoms, time to recovery from start of treatment and clinical outcomes. Patients with previous hematological pathologies or thrombocytopenia were excluded. Mild COVID-19 disease was defined by presence of fever and cough only. Moderate disease was defined by presence of unilateral pneumonia by radiological evidence and/or clinical worsening. Severe disease was defined by presence of bilateral pneumonia by radiological evidence, admission to intensive care unit (ICU) during admission or met criteria for ARDS. Response to treatment was defined by documentation of platelet doubling or platelet count reaching at least > 30 × 109 /L (partial response-PR) or level reached > 100 × 109 /L or up to baseline count of that patient (complete response-CR). The results are expressed in percentages for qualitative variables, and in means and interquartilic ranges for continuous variables. The data were included in an Excel database (Microsoft.) and the IBM SPSS Statistics. 20 program was used for their analysis. Results: A total of 27 patients were identified, 17 males (62.96%) and 10 females (37.03%). The mean age at the time of the event was 78 years old (interquartile range-IQR-: 28 years). Attending to severity, 15 had severe disease (55.5%), 9 moderate and only 3 patients (11%) had a mild presentation. The mean time from first COVID-19 manifestations to first ITP expression was 5 days (0-23). and in most of our patients was an incidental finding, presenting only 22% haemorragic clinic associated. The majority of patients in our study did not receive a specific treatment for suspected ITP (e.g. only 6 were treated with intravenous immunoglobulins which were needed due to bleeding). But most patients were already treated with low doses of steroids as part of their treatment for COVID-19. The response rate was about 63% (PR and CR), with a mean of response of six days (IQR of 6.5 days). Patients with severe disease and those who died at the end of the study, had lower platelet count than survivors and patients with moderate disease. However, our differences were not statisticaly significant. Summary/Conclusion: In our study, ITP was more frequent in severe COVID-19, with lower nadir platelet count, as described in literature. Bleeding events were infrequent. Glucocorticoids were used as a treatment for COVID-19 disease, only used in few patients as ITP specific treatment. The results should be confirmed with prospective randomized controlled studies.