Timeliness and Modality of Treatment for New Cancer Diagnoses During the COVID-19 Pandemic in Canada

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(1), P. e2250394 - e2250394

Published: Jan. 10, 2023

Importance The impact of COVID-19 on the modality and timeliness first-line cancer treatment is unclear yet critical to planning subsequent care. Objective To explore association pandemic with modalities wait times for first treatment. Design, Setting, Participants This retrospective population-based cohort study using administrative data was conducted in Ontario, Canada, among adults newly diagnosed between January 3, 2016, November 7, 2020. were followed up from date diagnosis 1 year, until death, or June 26, 2021, whichever occurred first, ensure a minimum 6-month follow-up time. Exposures Receiving vs prepandemic period, March 15, 2020, when elective hospital procedures halted. Main Outcomes Measures main outcome time-to-event variable describing number days receiving (surgery, chemotherapy, radiation) being censored. For each modality, multivariable competing-risk regression model used assess time period. A secondary continuous defined patients who treated 6 months after as waiting Results Among 313 499 patients, mean (SD) age 66.4 (14.1) years 153 679 (49.0%) male patients. Those during less likely receive surgery (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99) but more chemotherapy (sHR, 1.26; 1.23-1.30) radiotherapy 1.16; 1.13-1.20) first. received within (228 755 [73.0%]), their decreased 35.1 (37.2) 29.5 (33.6) surgery, 43.7 (34.1) 38.4 (30.6) 55.8 (41.8) 49.0 (40.1) radiotherapy. Conclusions Relevance In this study, significantly associated greater use nonsurgical therapy initial Wait shorter period those diagnosis. Future work needs examine how these changes may have affected patient outcomes inform future guideline development.

Language: Английский

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Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(1), P. e2253204 - e2253204

Published: Jan. 26, 2023

COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during first months of pandemic, this no longer be case for period.To examine approaches that may better assess use cancer surgeries.In cross-sectional design, nationwide French hospital facility data (Medicalised Information System Program) used to surgery 6 site categories in adults from January 1, 2010, December 31, 2021.Estimated activity pandemic.Three models expected number surgical procedures between 2020 and 2021 make comparison with those observed earlier years.In France, removal surgeries account approximately 7000 hospitalizations per year liver cancer; 4000 pancreatic 7700 ovarian 1300 esophagus 23 000 ear, nose, throat (ENT) 78 breast 16 600 thoracic cancers. For most sites, increased 2010 2019: liver, 14%; pancreas, 38%; ovary, esophagus, 18%; breast, 8%; thoracic, 29%. Assuming stability, these values underestimate gap 2020-2021. other procedures, decrease was observed: stomach, -10%, ENT, -6%. overestimate end 2021, according model, 2020-2021 estimated at -1.4% 1.7% -6.6% -7.3% -3.1% -2.5% ovarian, -4.2% -1.7% -6.7% 5.9% -13.0% -13.9% esophageal urologic cancers, because trend different before after 2015, it necessary opt modeling only recent period. The cumulative -1.0% ENT -5.3% -2.9% cancers.The findings study suggest short- medium-term trends must considered estimate activities. Breast is which showed smallest almost full recovery 2021.

Language: Английский

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Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers

Current Oncology, Journal Year: 2024, Volume and Issue: 31(7), P. 4038 - 4051

Published: July 17, 2024

Regular cervical screening can largely prevent the development of cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some lowest rates province. this study, we used concept mapping two stakeholder groups—South service users providers—to identify prioritize points intervention encourage uptake After participants brainstormed a master list statements, 45 rated statements based off ‘importance’ ‘ease address’ relation encouraging A bivariate plot (X-Y graph) that shows average rating values for each statement across variables (a ‘go-zone’ display) was produced display priorities implementation. Statements were considered high priority address reflected issues around education awareness including understanding communication related preventative care, as well need trusted sources information. but challenging implement centered fear, stigma, discomfort, family personal priorities. This study highlighted norms social relations impact must be addressed order raising effective move from conviction action.

Language: Английский

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Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada

JAMA Network Open, Journal Year: 2022, Volume and Issue: 5(8), P. e2225118 - e2225118

Published: Aug. 2, 2022

Importance

In response to an increase in COVID-19 infection rates Ontario, several systemic treatment (ST) regimens delivered the adjuvant setting for breast cancer were temporarily permitted neoadjuvant-intent defer nonurgent surgical procedures.

Objective

To examine use and compare short-term outcomes of vs ST era compared with pre–COVID-19 era.

Design, Setting, Participants

This was a retrospective population-based cohort study Canada. Patients starting selected (March 11, 2020, September 30, 2020) those 2019, March 10, 2020). diagnosed within 6 months therapy.

Main Outcomes Measures

Estimates calculated neoadjuvant ST, likelihood receiving procedure, rate emergency department visits, hospital admissions, infections, all-cause mortality between groups over time.

Results

Among total 10 920 patients included, 7990 (73.2%) started 7344 (67.3%) received ST; mean (SD) age 61.6 (13.1) years. Neoadjuvant-intent more common (1404 2930 [47.9%]) than pre–COVID–19 (2172 [27.2%]), odds ratio 2.46 (95% CI, 2.26-2.69;P < .001). trend consistent across range regimens, but differed according patient geography. The surgery following chemotherapy similar (log-rankP = .06). However, hormonal therapy significantly likely receive After adjustment, there no significant changes visits time or only during period postoperative period. Hospital admissions decreased who alone (Pfor interaction .01 both) either setting.

Conclusions Relevance

this study, start era, which varied province by indication. There limited evidence suggest any substantial impact on outcomes.

Language: Английский

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Prioritization of head and neck cancer patient care during the COVID-19 pandemic: A retrospective cohort study

Journal of Otolaryngology - Head and Neck Surgery, Journal Year: 2023, Volume and Issue: 52(1)

Published: Jan. 1, 2023

The COVID-19 pandemic placed considerable strain on the healthcare system, leading to re-allocation of resources and implementation new practice guidelines. objective this study is assess impact guideline modifications head neck cancer (HNC) care at two tertiary centers in Canada.A retrospective cohort was conducted. HNC patients seen before after onset (pre-pandemic: July 1st, 2019, February 29th, 2020; pandemic: March 2020, October 31st, 2020) were included. pre-pandemic cohorts compared according patient tumor characteristics, duration workup, treatment type duration. Mean differences wait times, including time diagnosis, board, as well total package postoperative hospital stay between cohorts. Univariate multivariate analyses used compare characteristics outcomes cohorts.Pre-pandemic (n = 132) 133) did not differ significantly sex, age, habits, or characteristics. percentage who received surgery only, chemo/radiotherapy (CXRT) plus adjuvant CXRT Pandemic experienced a significant reduction with regards date first by service until start ([Formula: see text] 48.7 76.6 days respectively; p .0001), presentation board 25.1 38 .001), mean for only 3.7 9.0 .017), 80.2 112.7 .035).The reduced during pre-pandemic. This transparent model patient-centered operative-room prioritization can serve improving resource allocation efficiency emergency non-emergency scenarios.

Language: Английский

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“It’s a low-key thing of eugenics”: Disability reproductive injustice in barriers to cervical cancer screening for people with disabilities during the COVID-19 pandemic

Social Science & Medicine, Journal Year: 2025, Volume and Issue: 369, P. 117807 - 117807

Published: Feb. 3, 2025

Cervical cancer screening (CCS) is a critical component of preventative sexual and reproductive healthcare, yet there are disparities in access to CCS for people with disabilities. This qualitative community-engaged study uses the disability justice framework examine how COVID-19 pandemic impacted disabilities' experiences Canada. From May 2022 March 2023, semi-structured interviews were conducted 40 women gender-diverse physical, sensory, cognitive, and/or mental health Results from thematic analysis indicate that barriers before during characterized by inaccessibility, ableism intersecting forms oppression, provider distrust, deprioritization disregard disabled people's autonomy. Grounded these findings, this article situates healthcare like as concern. Amplified pandemic, enacted injustice through everyday micro-eugenics devalued Barriers must be addressed collaboration communities. Guided participant insights, recommendations include making services more accessible available disabilities, especially aftermath public emergencies disproportionately impact

Language: Английский

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Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption

Health Policy, Journal Year: 2025, Volume and Issue: unknown, P. 105309 - 105309

Published: March 1, 2025

Language: Английский

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Association Between Pre‐Diagnostic Delay and Survival Among Patients With Esophageal and Gastric Cancer Treated With Curative Intent During the COVID19 Pandemic

Cancer Medicine, Journal Year: 2025, Volume and Issue: 14(9)

Published: May 1, 2025

ABSTRACT Background The majority of esophageal and gastric cancers are diagnosed at an advanced stage with poor overall survival (OS). Whether the pre‐diagnostic interval from symptom onset has any impact on OS is unclear. We investigated this question in peri‐COVID19 pandemic era. Methods retrospectively analyzed a cohort 308 patients esophageal, gastroesophageal junction, or carcinoma treated curative intent Princess Margaret Cancer Centre January 2017 to December 2021. Clinical details pertaining initial presentation were determined through retrospective chart review. Cox proportional hazards regression models used assess association between intervals OS, adjusting for baseline patient characteristics. Results median diagnosis was 98 days (IQR 47–169 days). Using cox hazard model, prolonged not associated worse (HR 1.00, p = 0.62). Comparing before during COVID19 pandemic, there notable increase diagnostic delay increasing 92 126 ( 0.007). Median age time 69.6 vs. 64.7 pandemic. Linear showed squamous cell histology significantly 0.04), but did hold true multivariable model. Looking other metrics, no changes treatment versus (median 1.7 weeks both), change resection those who underwent surgery. Conclusion caused significant presenting cancer. lack correlation may reflect underlying tumor biology as driving force that determines prognosis.

Language: Английский

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Developing Cancer Quality of Care Indicators to Quantify the Impact of a Global Destabilization of the Care System (COLLAT-COVID)

Cancers, Journal Year: 2025, Volume and Issue: 17(10), P. 1680 - 1680

Published: May 16, 2025

Background/Objectives: The COVID-19 pandemic led to significant disruptions in healthcare systems, particularly impacting cancer care through delays diagnoses and treatments. Quality indicators (QIs) are essential tools for monitoring performance, yet existing QIs may not be suited crises. This study aimed develop a set of hospital-based tailored assess the impact reorganization during health crises across four types: breast cancer, hepatocellular carcinoma, gynecological cancers (excluding ovarian cancer), peritoneal carcinomatosis. Methods: A multidisciplinary steering committee (SC) conducted five-stage process, including literature review, indicator selection, content validation via RAND/UCLA method, final by SC, pilot feasibility study. were assessed based on clinical relevance, reproducibility, sensitivity change, feasibility. Expert panels evaluated validated two rounds voting. Results: Among 150 initially identified QIs, 49 validated: 12 11 8 cancers, 18 Most (92%) process indicators, covering diagnosis, treatment, delays. Two common all cancers: team meeting discussions psychological support consultations. Conclusions: demonstrates developing crisis-responsive monitor system disruptions. Future work will focus their real-time implementation, international settings, integration into policies enhance crisis preparedness.

Language: Английский

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Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(10), P. e2340148 - e2340148

Published: Oct. 30, 2023

Importance The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, abrupt resource diversion toward patients with put cancer on hold for many patients. Previous reports have shown substantial declines in screening diagnoses 2020; however, extent which delivery care was altered remains unclear. Objective To assess alterations US during first year pandemic. Design, Setting, Participants This retrospective cohort study used data from National Cancer Database (NCDB) older than 18 years newly diagnosed January 1, 2018, December 31, 2020. Main Outcomes Measures main outcomes were accessibility (time treatment, travel distance, multi-institutional care), availability (proportional changes between years), utilization (reductions by modality, hospital type) 2020 compared 2018 2019. Autoregressive models forecasted expected findings based observations prior years. Results Of 1 229 654 identified NCDB 2020, 074 225 treated representing a 16.8% reduction what expected. Patients predominately female (53.8%), median age 66 (IQR, 57-74 similar demographics Median time diagnosis 26 days 0-36 days) distance 11.1 miles 5.0-25.3 miles), In fewer traveled longer distances (20.2% traveling &amp;gt;35 miles). proportions chemotherapy (32.0%), radiation (29.5%), surgery (57.1%) those Overall, 146 805 underwent surgery, 80 480 received radiation, 68 014 chemotherapy. Academic hospitals experienced greatest decrease approximately 484 (−19.0%) per 99 (−12.6%) at community 110 (−12.8%) integrated networks. Conclusions Relevance found that among access remained intact; reductions varied across modalities greater academic networks values. These results suggest resilience service lines frame economic losses

Language: Английский

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