Impact of the COVID-19 Pandemic on Management of Patients with Metastatic Pancreatic Ductal Adenocarcinoma in the United States.

BACKGROUND: The purpose of this study was to understand how the COVID-19 pandemic has affected health care patterns and outcomes for patients diagnosed with metastatic pancreatic ductal adenocarcinoma (mPDAC) in 2020 compared with those diagnosed with mPDAC in 2019. PATIENTS AND METHODS: We used the Flatiron Health database to identify adults diagnosed with mPDAC from March 1 to September 30, 2019 (pre-COVID-19 cohort) and March 1 to September 30, 2020 (post-COVID-19 cohort). Between-cohort comparisons included demographic and clinical characteristics and year-over-year data for diagnosis of mPDAC, newly treated patients, time to and types of first-line therapy, and adverse events (AEs) during first-line therapy. Overall survival (OS) and milestone survival rates were evaluated. Kaplan-Meier methods were used to assess OS. RESULTS: Pre-COVID-19 (n = 923) and post-COVID-19 (n = 796) cohorts had similar baseline demographic characteristics. A smaller proportion of patients in the pre-COVID-19 cohort were initially diagnosed with stage IV disease versus the post-COVID-19 cohort (62.2% vs 69.7%). Between 2019 and 2020, there was a 13.8% decrease in diagnosis of mPDAC and a 13.0% decrease in newly treated patients. Median (interquartile range) times to first-line treatment were similar (21 [13-40] and 19 [12-32] days). Median OS (months) was significantly longer in the pre-COVID-19 cohort (8·4 [95% CI: 7·5, 9·0]) versus the post-COVID-19 cohort (6·1 [95% CI: 5·4, 6·9]; P < .001). Survival rates were higher in the pre-COVID-19 versus post-COVID-19 cohorts. CONCLUSIONS: During the pandemic, patients were initially diagnosed with PDAC at more advanced stages. While patients in both cohorts appeared to receive similar care, survival outcomes were adversely affected.

Nutritional Screening: Development and Implementation of a Protocol in Patients With Head and Neck Cancer.

BACKGROUND: Half of all patients with head and neck cancer are malnourished at the time of diagnosis. Although nutritional status can be predictive of patient-related outcomes, nutritional screening protocols have not been widely accepted as standard of care. OBJECTIVES: This article aims to develop and pilot a nutritional screening protocol in an outpatient head and neck clinic using the abridged version of the Patient Generated Subjective Global Assessment (abPG-SGA) so that at-risk patients are identified and can maintain or minimize weight loss and body mass index (BMI). METHODS: At initial and subsequent visits, study participants completed the abPG-SGA, documenting percentage of weight loss and BMI from baseline. FINDINGS: 317 patients completed the abPG-SGA, with 119 scoring 6 or more, prompting a dietitian referral. The nutritional screening protocol accurately identified at-risk patients and resulted in less weight loss and BMI change.

Quality of Life in Head and Neck Cancer Patient-Caregiver Dyads: A Systematic Review.

BACKGROUND: As we learn about patient experiences with head and neck cancer, it is also important to consider caregivers so that family-centered care can be improved. OBJECTIVES: The purpose of this systematic review was to (a) identify the research questions, methods, and measures that have been examined in quality-of-life studies with head and neck cancer patients and their caregivers (dyads) and (b) identify gaps and future directions for research and practice. METHODS: We conducted a systematic search of electronic databases using keywords (head and neck cancer, caregiver, quality of life) and included studies that assessed quality of life-related constructs in both patients and caregivers. A dyadic quality-of-life conceptual model guided the summary of observations. RESULTS: Thirteen studies met eligibility criteria. The most common research questions included comparing patient and caregiver quality of life, examining relationships between personal and clinical factors in 1 dyad member and a quality-of-life outcome in the other, and exploring relationships between interpersonal processes and quality of life. Psychological quality-of-life constructs were most commonly studied. There was substantial variability in study findings, in part due to differences in study questions and samples. CONCLUSIONS: Future research is needed to examine longitudinal interpersonal processes in head and neck cancer. Unique caregiving tasks should be inventoried, and dyadic data analysis techniques should be used. IMPLICATIONS FOR PRACTICE: Head and neck cancer dramatically affects quality of life in patients and caregivers, and quality clinical care requires a dyadic focus. Oncology nurses have a unique opportunity to develop and implement dyadic illness management models for head and neck cancer.