Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme.

INTRODUCTION: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. OBJECTIVES: The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. METHODS: The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). RESULTS: During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. CONCLUSIONS: Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.

Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation.

BACKGROUND: Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation. PATIENTS AND METHODS: Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process. RESULTS: A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis. CONCLUSIONS: The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting.

Abordaje del problema de la hipertensión desde una oficina de farmacia: detección, educación sanitaria o seguimiento farmacoterapéutico. ¿Qué actuación muestra mayor eficiencia? / Approaching the problem of hypertension from a pharmacy: detection, health education and monitoring. Which activity shows more efficiency?

Introducción: La prevalencia de la hipertensión arterial en España aumenta con los años. Nos proponemos evaluar la función del farmacéutico desde la farmacia comunitaria como instrumento muy útil para mejorar el control y el manejo del paciente hipertenso, evaluando y comparando la eficiencia de las diferentes intervenciones que puede realizar para beneficiar al paciente hipertenso: detección de cifras altas de presión arterial (PA), educación sanitaria y seguimiento farmacoterapéutico. Método: Estudio observacional, prospectivo y de intervención, llevado a cabo en una farmacia de Valencia. Se ofertaba la toma de la PA a los participantes y se les pasaba una encuesta. Los pacientes eran asignados de forma aleatoria a un tipo de intervención: consejo farmacéutico, educación sanitaria o seguimiento farmacoterapéutico. A los 6 meses se evaluó la intervención. Resultados: Se propone la inclusión en el estudio a 220 pacientes, y aceptan participar 207, que se clasifican en 65 normotensos (31,4%), 64 prehipertensos (30,9%) y 78 hipertensos (37,7%). De los hipertensos, el 40% desconocía sus cifras elevadas de PA, y remitimos a los pacientes al médico. Se realizó un seguimiento farmacoterapéutico durante 6 meses en el grupo de pacientes con cifras de PA >140/90 mmHg, observándose diferencias en función de la actuación farmacéutica realizada. Conclusiones: El farmacéutico comunitario puede ser un elemento clave para conseguir mejorar la salud cardiovascular. Los programas de cribado de pacientes hipertensos parecen ser más coste-efectivos que el seguimiento semanal del paciente hipertenso(AU)

Introduction: The prevalence of hypertension in Spain is increasing over the years. In this study we evaluated the role of the community pharmacist as useful tool to improve the control and management of hypertensive patients. We evaluated and compared the effectiveness of three different interventions which could be developed in the community pharmacy to benefit hypertensive patients: detection of high blood pressure, health education and pharmaceutical care. Method: A prospective observational and intervention study was carried out in a community pharmacy from Valencia (Spain). Blood pressure determination was offered to adult people entering to the pharmacy. They answered a survey and the pharmacist acted differently depending on the day of the week: counseling, sanitary education and pharmaceuthical care, at 6 months, the pharmacist intervention were evaluated. Results: The study was proposed to 220 patients and 207 accepted. They are classified as normotensive (31.4%), prehypertensive (30.9%) and hypertensive (37.7%) depending on their arterial pressure. 40% of hypertensive patients, ignore their high levels blood pressure. In these cases, patients were referred to the doctor. In the group of patients with blood pressure above 140/90 mmHg, patients were followed for 6 months. Differences observed depending on the pharmacist actuation. Conclusions: The community pharmacist can be a key element in achieving better results in cardiovascular health. The implementation of screening programs in hypertensive patients appears to be more cost/effective than weekly monitoring of hypertensive patients(AU)

Síndrome antifosfolipídico catastrófico y adenocarcinoma de páncreas / Catastrophic antiphospholipid syndrome and pancreatic cancer

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Intracardiac thrombosis in a case of Behcet's disease associated with the prothrombin 20210G-A mutation.

Thrombosis occurs in 20 to 30% of patients with Behçet's disease (BD), but the precise pathogenic mechanism underlying the thrombotic tendency in these patients is not well known. Venous thromboses are commonly located in the lower extremities, but right intracardiac thrombi are extremely rare. We report for the first time on a young patient with BD associated the 20210G-A prothrombin gene mutation and right intracardiac thrombosis. We suggest that the association of BD with this newly recognized prothrombotic genetic mutation may have contributed to the development of the thrombotic event in this patient.