Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter

Araújo, Sérgio Eduardo Alonso; Leal, Alessandro; Centrone, Ana Fernanda Yamazaki; Teich, Vanessa; Malheiro, Daniel Tavares; Cypriano, Adriana Serra; Neto, Miguel Cendoroglo; Klajner, Sidney

doi:10.31744/einstein_journal/2021ao6282

Cited by 53 publications

(65 citation statements)

References 10 publications

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“… 4 , 13 Brazil has also reported a 35% reduction in newly diagnosed cancer cases, a 45–55% decline in cancer care appointments, a more than 50% decrease in patients undergoing systemic treatment, and a 60% decrease in cancer surgeries. 14 In Chile, which has reliable data for several cancers both before and during the COVID-19 pandemic, administrative data suggest that there has been a reduction of more than 60% in the number of new cancer diagnoses, as well as a 50% reduction in surgical procedures for individuals with cancer between April and June, 2020, 15 shortly after the introduction of a national lockdown in March, 2020. In this study, based on data provided by the Chile Ministry of Health, we estimate the impact of delayed diagnosis on cancer outcomes in Chile using a novel modelling approach to provide information for decision makers that can inform policies and planning to mitigate the forthcoming cancer-related health impacts in Chile.…”

Section: Introductionmentioning

confidence: 99%

Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis

Ward

Walbaum

et al. 2021

The Lancet Oncology

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Background The COVID-19 pandemic has strained health system capacity worldwide due to a surge of hospital admissions, while mitigation measures have simultaneously reduced patients' access to health care, affecting the diagnosis and treatment of other diseases such as cancer. We estimated the impact of delayed diagnosis on cancer outcomes in Chile using a novel modelling approach to inform policies and planning to mitigate the forthcoming cancer-related health impacts of the pandemic in Chile. Methods We developed a microsimulation model of five cancers in Chile (breast, cervix, colorectal, prostate, and stomach) for which reliable data were available, which simulates cancer incidence and progression in a nationally representative virtual population, as well as stage-specific cancer detection and survival probabilities. We calibrated the model to empirical data on monthly detected cases, as well as stage at diagnosis and 5-year net survival. We accounted for the impact of COVID-19 on excess mortality and cancer detection by month during the pandemic, and projected diagnosed cancer cases and outcomes of stage at diagnosis and survival up to 2030. For comparison, we simulated a no COVID-19 scenario in which the impacts of COVID-19 on excess mortality and cancer detection were removed. Findings Our modelling showed a sharp decrease in the number of diagnosed cancer cases during the COVID-19 pandemic, with a large projected short-term increase in future diagnosed cases. Due to the projected backlog in diagnosis, we estimated that in 2021 there will be an extra 3198 cases (95% uncertainty interval [UI] 1356–5017) diagnosed among the five modelled cancers, an increase of nearly 14% compared with the no COVID-19 scenario, falling to a projected 10% increase in 2022 with 2674 extra cases (1318–4032) diagnosed. As a result of delayed diagnosis, we found a worse stage distribution for detected cancers in 2020–22, which is estimated to lead to 3542 excess cancer deaths (95% UI 2236–4816) in 2022–30, compared with the no COVID-19 scenario, among the five modelled cancers, most of which (3299 deaths, 2151–4431) are projected to occur before 2025. Interpretation In addition to a large projected surge in diagnosed cancer cases, we found that delays in diagnosis will result in worse cancer stage at presentation, leading to worse survival outcomes. These findings can help to inform surge capacity planning and highlight the importance of ensuring appropriate health system capacity levels to detect and care for the increased cancer cases in the coming years, while maintaining the timeliness and quality of cancer care. Potential delays in treatment and adverse impacts on quality of care, which were not considered in this model, are likely to contribute to even more excess deaths from cancer than projected. Funding Harvard TH Chan School of Public Health. Translations For the...

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Section: Introductionmentioning

confidence: 99%

Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis

Ward

Walbaum

et al. 2021

The Lancet Oncology

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“…Esse fato, pode justificar o aumento expressivo do número de internação no HUL no período do estudo, uma vez, que o hospital não é referência em atendimento de câncer, mas é referência no tratamento da COVID-19. Adicionalmente, com profissionais de saúde desviados para enfrentamento da crise, restrição de medicamentos (sedativos, bloqueadores neuromusculares, anestésicos), grande consumo de insumos (equipamentos de proteção individual), impossibilidade de viajar e frequentar os centros de apoio e tratamento, o medo e o aumento do risco de contágio, agravamento e morte decorrentes da imunossupressão (Dai et al, 2020;Emanuel et al, 2020), muitos pacientes interromperam o tratamento (Araujo et al, 2021) e outros, pela superlotação dos hospitais, falta de leitos e suspensão da marcação de exames (Emanuel et al, 2020) nem começaram o tratamento.…”

Section: Discussionunclassified

“…Estudos têm sugerido uma maior mortalidade em pacientes com câncer e diagnosticados com COVID-19, apesar da manifestação dos sintomas ser leve (Araujo et al, 2021;Kuderer et al, 2020;Lee et al, 2020;Tian et al, 2020;Turaga & Girotra, 2020). Lee et al (2020), em estudo observacional prospectivo, observaram associação da mortalidade com a idade, sexo e comorbidades.…”

Section: Introductionunclassified

Perfil sociodemográfico e clínico de pacientes com câncer no contexto da pandemia da COVID-19 em um Hospital Universitário do Nordeste: estudo transversal

Júnior

Silva

Almeida

et al. 2021

RSD

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A pandemia do COVID-19 gerou sobrecarga dos serviços público de saúde tornando-se uma barreira para administração de terapias anticâncer. A reestruturação dos serviços de saúde e a vulnerabilidade dos pacientes oncológicos contribuíram para a interrupção do tratamento anticâncer. Assim, o objetivo foi descrever o perfil sociodemográfico, clínico e principais desfechos dos pacientes adultos e idosos com câncer internados em um hospital universitário (HU), submetidos à intervenção da Fisioterapia, considerando período prévio e atual à pandemia. Estudo exploratório e retrospectivo envolvendo 71 pacientes oncológicos internados no HU nos anos de 2019 e 2020. Os dados epidemiológicos foram coletados por meio de prontuários eletrônicos. Os critérios de elegibilidade foram registro do CID primário relacionado a neoplasia e faixa etária (≥ 30 e ≥ 60 anos). A análise estatística considerou as variáveis confundidoras: idade, sexo, local onde reside, tipo de neoplasia, desfecho clínico (alta ou óbito), condutas de fisioterapia (oxigenioterapia, ventilação mecânica invasiva e não invasiva) tempo de internação. Os resultados demonstram que o sexo não foi uma variável determinante para internação. Maior incidência de internação foram observados em idosos, afrodescendentes, pacientes com câncer de cólon e reto, pulmão e, em igual percentual, cânceres de mama, estômago e orofaringe. Os pacientes que necessitaram de acompanhamento fisioterapêutico e de oxigenoterapia evoluíram o desfecho óbito, independente do tipo de intervenção (suporte ventilatório mecânico invasivo ou não invasivo). Houve diferença entre a quantidade de admissões e desfechos alta e óbito no ano de 2020 quando comparado com 2019.

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“…The COVID-19 pandemic has caused substantial disruption to the detection and treatment of cancer worldwide [1][2][3] . The diversion of health services toward the pandemic response, combined with reduced access to screening, primary care and secondary treatment transmission 7 .…”

Section: Introductionmentioning

confidence: 99%

“…The COVID-19 pandemic has caused substantial disruption to the detection and treatment of cancer worldwide [1] , [2] , [3] . The diversion of health services toward the pandemic response, combined with reduced access to screening, primary care and secondary treatment services, has resulted in a downturn in cancer registrations and, in some regions heavily impacted by the crisis, a probable increase in cancer mortality 4 .…”

Section: Introductionmentioning

confidence: 99%

Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience

Millar¹,

Gurney²,

Beuker³

et al. 2021

The Lancet Regional Health - Western Pacific

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COVID-19 caused significant disruption to cancer services around the world. The health system in Aotearoa New Zealand has fared better than many other regions, with the country being successful, so far, in avoiding sustained community transmission. However, there was a significant initial disruption to services across the cancer continuum, resulting in a decrease in the number of new diagnoses of cancer in March and April 2020.Te Aho o Te Kahu, Aotearoa New Zealand's national Cancer Control Agency, coordinated a nationwide response to minimise the impact of COVID-19 on people with cancer. The response, outlined in this paper, included rapid clinical governance, a strong equity focus, development of national clinical guidance, utilising new ways of delivering care, identifying and addressing systems issues and close monitoring and reporting of the impact on cancer services.Diagnostic procedures and new cancer registrations increased in the months following the national lockdown, and the cumulative number of cancer registrations in 2020 surpassed the number of registrations in 2019 by the end of September. Cancer treatment services -surgery, medical oncology, radiation oncology and haematology -continued during the national COVID-19 lockdown in March and April 2020 and continued to be delivered at pre-COVID-19 volumes in the months since. We are cautiously optimistic that, in general, the COVID-19 pandemic does not appear to have increased inequities in cancer diagnosis and treatment for M āori in Aotearoa New Zealand.

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Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter

Cited by 53 publications

References 10 publications

Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis

Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis

Perfil sociodemográfico e clínico de pacientes com câncer no contexto da pandemia da COVID-19 em um Hospital Universitário do Nordeste: estudo transversal

Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience

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