Morphology,TNM Staging and Survival with Pancreaticoduodenectomy Specimens received at Shaukat Khanum Memorial Cancer Hospital and Research Centre,Pakistan

Background: Whipple specimens consists of duodenum from the pylorus to the ligament of Treitz, the head ofthe pancreas and distal extrahepatic biliary tract, sometimes with most distal portion of the stomach. Adequategross handling of the specimen and assessment of histological variables is of prognostic importance. Methods:At the Pathology Department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, we hereevaluated survival with a total of 65 pancreaticoduodenectomy specimens from 2006 to 2010 with reference tohistological parameters like tumour type, site, size, grade, pT, pN, margin status and perineural invasion, andcompared our results with international data. Patients were followed up and P-values were calculated regardingassociation between survival and prognostic factors, Kaplan-meier survival curves also being plotted. Results:Most of the patients were males (60%), with a mean age of 50 yrs. The most frequent site was periampullaryregion (43.2%), with adenocarcinoma, NOS accounting for 72.4%. G2 was the most common grade (58.5%) andthe most frequent pT was pT2 (52.4%), nearly half presenting with lymph node metastasis (47.7%). Significantassociations (p<0.05) were noted for survival with grade, pT, pN, margins, tumor size and perineural invasion,but not tumor site, tumor type and age. Kaplan-Meier curve revealed that at end of 1 month, 70% of the patientswere alive, this decreasing to 40%, 15% and 5% and at the end of 6 months, 1 year and 2 years. Conclusion:Tumor size, type, pathologic T and N staging, margins and perineural invasion are directly related to survivalwith pancreatico-duodenal lesions.     

Pediatric Nasopharyngeal Carcinoma: A Review of 27 Cases over 10 Years at Shaukat Khanum Memorial Cancer Hospital and Research Center,Pakistan

Purpose: This study aims to review the clinical features, treatment and outcome of pediatric nasopharyngealCarcinoma at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) over tenyears. Methods: Retrospective review of pediatric patients who were diagnosed with nasopharyngeal carcinomaand treated at SKMCH&RC from July 1996 to June 2006. Results: A total of 27 children with NPC wereincluded. The male to female ratio was 4.4:1. The mean age at diagnosis was 14 years (8-18 years). The mostcommon presenting symptom was neck swelling (81.5%, 22/27). The mean duration of symptoms before diagnosiswas 10.3 months (3-36 months). The majority of patients (70%, 19/27) presented at stage IV. All received acombination of chemotherapy and radiotherapy. Survival analysis was performed for 22 patients; of these 8patients died and 4 were lost to follow-up. The median follow-up time of the surviving patients was 53 months(5-116 months). At 5 years, the cumulative overall survival (OS) was 55% while the cumulative EFS was 54%with a flattening of the curve at 2 years. There was a significant difference in OS (p=0.001) and EFS (p=0.057) inpatients diagnosed with NPC under 14 years of age (n=11) and those between 14 and 18 years (n=11). Conclusion:In our institutional study, NPC presents late and in advanced stage. The outcome is better in younger children.Our survival rates, while comparable to developing countries, are less than those seen in the developed world.We feel a strong need for collaborative studies in view of small numbers in individual centres.     

Decreased Global Interest in Oral Cancer During the COVID-19 Pandemic

Objective: Oral cancer is one of the most common malignancies in developing countries, but studies using global data are scarce. The aim of this study is to analyze the search interests for oral cancer using mouth cancer, tongue cancer, gum cancer, and lip cancer as common keywords. Methods: Internet searches relating to oral cancer from 2010 to 2020, from 250 countries and dependent areas, were retrieved from Google Trends. Color densities in a heat map were used to show geographic differences. Kruskal-Wallis test with post hoc Dunn’s analysis was used to perform yearly comparisons of searches for mouth cancer, tongue cancer, gum cancer, and lip cancer. Search results within 2020 were also compared to determine differences. Forecasting searches from 2021 to 2022 were done by fitting time series models. Results: From 29 of 250 (11.6%) countries, the highest search values were observed for mouth cancer in Sri Lanka, Qatar, Bangladesh, Finland, Netherlands, Spain, and France. Compared to 2020, greater searches were seen in 2018 (Mdn = 91%, P = 0.023) and 2019 (Mdn = 94%, P = 0.012) for mouth cancer, and 2019 (Mdn = 17%, P = 0.035) for lip cancer. The relative search volumes for gum cancer and lip cancer were substantially lower than mouth cancer during the COVID-19 pandemic. Conclusion: Higher-income countries tend to be more interested in seeking information about oral cancer. Noteworthy decline in the interest in seeking information online for oral cancer may have crucial implications during the COVID-19 pandemic. Google Trends offer an invaluable and inexpensive means for oral cancer surveillance and health-seeking behavior.     

Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia

Background: Patients have had their cancer care either postponed or changed to telehealth visits to reduce exposure to COVID-19. However, it is unclear how these changes may have affected their experiences. We aim to identify patient characteristics that affect telehealth experiences and evaluate their preferences for using telehealth in the future. Methods: Patients who completed the Outpatient Cancer Care (OCC) Patient Experience Survey were invited to participate. They comepleted the modified OCC Survey, which focused on telehealth during the pandemic. Linear and logistic regression analyses were used to identify patient characteristics that influenced telehealth experiences and preferences for future telehealth use. Results: Perceived ease of participation in telehealth is a significant predictor of the change in patients’ ratings of their telehealth experience. We found that cancer patients had lower preferences for using telehealth in the future if they were older, female, or non-white; resided in an urban area; had no previous telehealth experience; had lower education; and had poorer mental health. Conclusions: To optimize cancer care and improve equitable access to high-quality telehealth care during the pandemic and beyond, clinicians and policymakers will need to consider patients’ self-reported experiences and their personal characteristics.     

Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer

IntroductionThe use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients'' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship.MethodsBetween March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit.ResultsOf 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio [OR] = 2.41, p = .01; OR = 3.34, p = .03, respectively).ConclusionTelemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.Implications for PracticeDuring the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients'' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.     

Feasibility and Predictive Performance of a Triage System for Patients with Cancer During the COVID-19 Pandemic

BackgroundTriage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID‐19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting.Materials and MethodsThis retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID‐19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed.ResultsA self‐report triage questionnaire identified 6% of triage‐positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%–85.4%), a specificity of 94.3% (95% CI, 93.5%–95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%–8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13–2.53, p = .01), younger age (OR, 1.52; 95% CI, 1.15–2.01, p < .01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44–16.6, p < .0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission.ConclusionA self‐report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) symptoms. Differential diagnosis with tumor‐ or treatment‐related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process''s overall sensitivity, and widespread SARS‐CoV‐2 testing should be implemented to identify asymptomatic carriers.Implications for PracticeThis is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire‐based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) symptoms, and a differential diagnosis with tumor‐ or treatment‐related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS‐CoV‐2 infection should be implemented to identify asymptomatic carriers.     

Temporal Trends in Inpatient Oncology Census Before and During the COVID-19 Pandemic and Rates of Nosocomial COVID-19 Among Patients with Cancer at a Large Academic Center

BackgroundThe coronavirus disease 2019 (COVID‐19) pandemic has significantly impacted health care systems. However, to date, the trend of hospitalizations in the oncology patient population has not been studied, and the frequency of nosocomial spread to patients with cancer is not well understood. The objectives of this study were to evaluate the impact of COVID‐19 on inpatient oncology census and determine the nosocomial rate of COVID‐19 in patients with cancer admitted at a large academic center.Materials and MethodsMedical records of patients with cancer diagnosed with COVID‐19 and admitted were reviewed to evaluate the temporal trends in inpatient oncology census during pre–COVID‐19 (January 2019 to February 2020), COVID‐19 (March to May 2020), and post–COVID‐19 surge (June to August 2020) in the region. In addition, nosocomial infection rates of SARS‐CoV‐2 were reviewed.ResultsOverall, the daily inpatient census was steady in 2019 (median, 103; range, 92–118) and until February 2020 (median, 112; range, 102–114). However, there was a major decline from March to May 2020 (median, 68; range, 57–104), with 45.4% lower admissions during April 2020. As the COVID‐19 surge eased, the daily inpatient census over time returned to the pre–COVID‐19 baseline (median, 103; range, 99–111). One patient (1/231, 0.004%) tested positive for SARS‐CoV‐2 13 days after hospitalization, and it is unclear if it was nosocomial or community spread.ConclusionIn this study, inpatient oncology admissions decreased substantially during the COVID‐19 surge but over time returned to the pre–COVID‐19 baseline. With aggressive infection control measures, the rates of nosocomial transmission were exceedingly low and should provide reassurance to those seeking medical care, including inpatient admissions when medically necessary.Implications for PracticeThe COVID‐19 pandemic has had a major impact on the health care system, and cancer patients are a vulnerable population. This study observes a significant decline in the daily inpatient oncology census from March to May 2020 compared with the same time frame in the previous year and examines the potential reasons for this decline. In addition, nosocomial rates of COVID‐19 were investigated, and rates were found to be very low. These findings suggest that aggressive infection control measures can mitigate the nosocomial infection risk among cancer patients and the inpatient setting is a safe environment, providing reassurance.     

Impact of the COVID-19 Pandemic on the Diagnosis and Surgery of Breast Cancer: A Multi-Institutional Study

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the rates of screening, case identification, and referral for cancer diagnosis. We investigated the diagnosis and surgery status of breast cancer before and after the COVID-19 pandemic at a multi-institutional level.MethodsWe collected breast cancer data from the clinical data warehouse which contained the medical records of patients from six academic institutions in South Korea. Patients were divided into two groups: February to April (period A) and May to July (period B). The data from the two groups were then compared against the same periods in 2019 and 2020. The primary objective was to investigate the differences in breast cancer stages before and after the COVID-19 pandemic.ResultsAmong 3,038 patients, there was a 9.9% reduction in the number of diagnoses in 2020. This decrease was more significant during period A than period B. The breast cancer stage was not statistically different in period A (p = 0.115), but it was in period B (p = 0.001). In the subset analysis according to age, there was a statistical difference between 2019 and 2020 in period B for patients under the age of 65 years (p = 0.002), but no difference was observed in the other groups.ConclusionThe number of breast cancer cases declined during the pandemic, and the staging distribution has changed after the pandemic peak.     

Impact of COVID-19 Pandemic on Colorectal Cancer Screening Program

IntroductionOne of the main clusters of coronavirus disease-2019 (COVID-19) has been identified in Italy. Following European and local guidelines, Italian endoscopy units modulated their activity. We aimed at analyzing the need and safety to continue selective colorectal cancer screening (CRCS) colonoscopies during the COVID-19 pandemic.Patients and MethodsWe carried out a retrospective controlled cohort study in our “COVID-free” hospital to compare data of the CRCS colonoscopies of the lockdown period (March 9 to May 4, 2020) with those of the same period of 2019 (control group). A pre/post endoscopic sanitary surveillance for COVID-19 infection was organized for patients and sanitary staff.ResultsIn the lockdown group, 60 of 137 invited patients underwent endoscopy, whereas in the control group, 238 CRCS colonoscopies (3.9-fold) were performed. In the lower number of examinations during the lockdown, we found more colorectal cancers (5 cases; 8% vs. 3 cases; 1%; P = .002). The “high-risk” adenomas detection rate was also significantly higher in the “lockdown group” than in controls (47% vs. 25%; P = .001). A multiple regression analysis selected relevant symptoms (hazard ratio [HR], 3.1), familiarity (HR, 1.99), and lockdown period (HR, 2.2) as independent predictors of high-risk lesions (high-risk adenomas and colorectal cancer). No COVID-19 infections were reported among staff and patients.ConclusionsThe overall adherence to CRCS decreased during the pandemic, but the continuation of CRCS colonoscopies was efficacious and safe.     

COVID-19 Pandemic Stressors and Psychological Symptoms in Breast Cancer Patients

Background. The current Coronavirus disease 2019 (COVID-19) pandemic is a highly stressful event that may lead to significant psychological symptoms, particularly in cancer patients who are at a greater risk of contracting viruses. This study examined the frequency of stressors experienced in relation to the ongoing coronavirus pandemic and its relationship with psychological symptoms (i.e., anxiety, depression, insomnia, fear of cancer recurrence) in breast cancer patients. Methods. Thirty-six women diagnosed with a non-metastatic breast cancer completed the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, the severity subscale of the Fear of Cancer Recurrence Inventory, and the COVID-19 Stressors Questionnaire developed by our research team. Participants either completed the questionnaires during (30.6%) or after (69.4%) their chemotherapy treatment. Results. Results revealed that most of the participants (63.9%) have experienced at least one stressor related to the COVID-19 pandemic (one: 27.8%, two: 22.2%, three: 11.1%). The most frequently reported stressor was increased responsibilities at home (33.3%). Higher levels of concerns related to the experienced stressors were significantly correlated with higher levels of anxiety, depressive symptoms, insomnia, and fear of cancer recurrence, rs(32) = 0.36 to 0.59, all ps < 0.05. Conclusions. Cancer patients experience a significant number of stressors related to the COVID-19 pandemic, which are associated with increased psychological symptoms. These results contribute to a better understanding of the psychological consequences of a global pandemic in the context of cancer and they highlight the need to better support patients during such a challenging time.     

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic.Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.     

COVID-19 in Patients with Cancer: A Retrospective Study of 212 Cases from a French SARS-CoV-2 Cluster During the First Wave of the COVID-19 Pandemic

We describe a large series of patients with solid tumors in an early COVID‐19 cluster in the eastern part of France. From February to May 2020, this multicenter retrospective study enrolled 212 patients with cancer under treatment or on follow‐up for any type of malignant solid tumor and positive for SARS‐CoV‐2. The mortality rate was 30%. Patients with gastrointestinal cancers were identified as a subset of more vulnerable patients; immunotherapy and radiotherapy within 3 months from COVID‐19 diagnosis were risk factors for death. The reported data support the essential need to be proactive and weigh the risks of morbidity from COVID‐19 against the magnitude of benefits of intended cancer therapies during this pandemic.Implications for PracticeThis article supports the essential need to be proactive (treatment delay or modification) in oncology in the setting of pandemic. This study identified patients with gastrointestinal cancers as a more vulnerable subset of patients with cancer and found that immunotherapy and radiotherapy within 3 months from COVID‐19 diagnosis to be risk factors for death. The reported data indicate the necessity of weighing the risks of morbidity from COVID‐19 against the magnitude of benefits of intended cancer therapies in any future wave of COVID‐19.     

Satisfaction among Cancer Patients Undergoing Radiotherapy during the COVID-19 Pandemic: An Institutional Experience

The COVID-19 pandemic has shifted oncology practices to prioritize patient safety while maintaining necessary treatment delivery. We obtained patient feedback on pandemic-based practices in our radiotherapy department to improve quality of patient care and amend policies as needed. We developed a piloted questionnaire which quantitatively and qualitatively assessed patients’ pandemic-related concerns and satisfaction with specific elements of their care. Adult patients who were treated at our Centre between 23 March and 31 May 2020, had initial consultation via telemedicine, and received at least five outpatient fractions of radiotherapy were invited to complete the survey by telephone or online. Relative frequencies of categorical and ordinal responses were then calculated. Fifty-three (48%) out of 110 eligible patients responded: 32 patients by phone and 21 patients online. Eighteen participants (34%) admitted to feeling anxious about hospital appointments, and only five (9%) reported treatment delays. Forty-eight patients (91%) reported satisfaction with their initial telemedicine appointment. The majority of patients indicated that healthcare workers took appropriate precautions, making them feel safe. Overall, all 53 patients (100%) reported being satisfied with their treatment experience during the pandemic. Patient feedback is needed to provide the highest quality of patient care as we adapt to the current reality.     

Fast-Tracking of Publication Times of Otolaryngology Papers During the COVID-19 Pandemic

To study the impact of the COVID-19 pandemic on journal processing times before publication in the field of otolaryngology-head and neck surgery (ORL-HNS). Online search of original papers published in selected ORL-HNS journals in terms of times from submission to acceptance (S-A), acceptance to first online publication (A-P), and submission to online publication (S-P). Papers were divided into those published in the pre-COVID-19 era and those during the COVID-19 era. The latter were further divided into unrelated to COVID-19 and related to COVID-19. A total of 487 articles from 5 selected ORL-HNS journals were included, of which 236 (48.5%) were published during the pre-COVID-19 era and 251 (51.5%) were published during the COVID-19 era. Among them, 180 (37%) papers were not related to COVID-19, and 71 (14.5%) were related to COVID-19. The S-A duration of COVID-19-related articles was significantly shorter compared to papers submitted in the pre-COVID-19 era and to papers submitted in the COVID-19 era but unrelated to COVID-19 (median 6–34 days compared to 65–125 and 46–127, respectively) in all 5 journals. The most prominent reductions in S-A and S-P times were documented in the laryngology and otology/neurotology disciplines, respectively. Processing times of the included papers were significantly shorter in most of the selected ORL-HNS journals during the COVID-19 era compared to the pre-COVID-19 era. COVID-19-related papers were processed more rapidly than non-COVID-19-related papers. These findings testify to the possibility of markedly expediting S-P times and hopefully set a precedent for post-pandemic publishing schedules.