Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from the Italian Health System to react to an unprecedented condition became necessary and sudden. COVID-19 pandemic required oncologists to redefine clinical organization and management of cancer patients. The aim of our study was to take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients management.
Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of 45 questions ranging from individual perception of pandemic management by oncological centers to physicians and nurses psychological distress and patient care. The survey was anonymous and broadcasted to oncology health workers by mailing contacts, word of mouth and social networks.
Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and from central Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganized routine clinical activity, but only 41% was adequately trained about the required procedures. 20% of the survey attendees think they have not received adequate and timely protective devices with respect to clinical needs and according to 58% the supply of these devices was only partial. 34% of professionals declared they do not have or know a defined common guideline to reschedule patients' treatments. More than 80% of interviewees declared to feel worry about being at greater risk of contagion than the general population, 92% feared to transmit virus to family members. Deferring treatments has caused fear / anxiety in 228 of the interviewed (60%). Symptoms of stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood (69%) and lower concentration ability (49%).
Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response quality has been heterogeneous, and several drawbacks emerged from this first analysis. Information, protection, testing, and training of healthcare professionals are keywords that should be kept in mind to encourage recovery after this tragedy and to be ready to face a similar emergency in the next future.
Legal entity responsible for the study: The authors.
Funding: Has not received any funding. Background: There are no large reported series determining the outcome of cancer patients with COVID-19. We aimed to determine whether differences exist in COVID-19 related mortality between cancer patients and the general population in our hospital, and we also describe associated risk factors.
Methods: We reviewed 2216 medical records of all patients admitted to hospital with COVID-19 diagnosis between 5 March and 13 May 2020. Study data were collected using REDCap electronic data capture tools. We described COVID-19 cumulative incidence in cancer patients, treatment outcome, mortality and associated risk factors. Background: We aimed to assess the impact of the COVID-19 crisis on 1) perceived changes in cancer treatment and follow-up care; and 2) cancer patients' wellbeing in comparison with a norm population.
Methods: Patients participating in the PROFILES (Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship) registry and a norm population were invited to complete a questionnaire mid-April 2020. Analyses included cohorts of colon, rectal, breast, melanoma, gynecological, prostate, hematological, pancreas, and esophagogastric cancer patients diagnosed between 1/2006 and 3/2020. Logistic regression analysis assessed factors associated with changes in cancer care. General Linear Models were computed to assess differences in QoL, anxiety/depression and loneliness between patients and age-and sex matched norm participants.
Results: Of 3,960 cancer patients, 213/768 (28%) in treatment and 448/2575 (17%) in follow-up reported that their treatment or appointment was cancelled or replaced by a telephone consult (TC) in the COVID-19 crisis. Older age, type of cancer, higher BMI, more comorbidities, metastasized cancer and being worried about getting infected with SARS-CoV-2 were independently associated with these changes. Twelve percent of cancer patients had their consultation replaced by a TC, and although most patients preferred a face-to-face consultation, 39% said that they would like to use a TC again. Cancer patients were a bit more worried about getting infected with SARS-CoV-2 (22%) compared to the 900 norm participants (17%). Remarkably, norm participants had worse QoL scores than measured before the crisis, and we did not see clinically relevant differences with the QoL scores of cancer patients in the current comparison. Norm participants more often reported depression (13% vs. 10%) and loneliness (11% vs. 7%) than cancer patients (p<0.05).
Conclusions: Up to one in four cancer patients reported changes in cancer care in the first weeks of the COVID-19 crisis, associated with vulnerability factors. Follow-up will show its impact on outcomes. The crisis seems to have more impact on QoL and mental wellbeing in the norm population than in cancer patients.
Legal entity responsible for the study: The authors. Results: Among 910 physicians that participated in the study, 55% were males, 67% medical or clinical oncologists and 58% worked in public hospitals. Only 213 (23%) reported being officially involved in COVID-19 control efforts. Level of knowledge regarding the prevention and transmission of the virus was good among 63% of participants. Majority (92%) were worried about contracting the virus either extremely (30%) or mildly (62%) and 85% were worried about transmitting the virus to their families. 77% reported they would take the COVID-19 vaccine once available, although only 38% got the flu vaccine regularly. Adherence to strict precautions was variable including social distancing outside work (68%), no hand shaking (58%), and hand washing (98%). Participation in virtual activities included clinics (54%), tumor boards (45%), administrative meetings (38%); and educational activities (68%) and majority reported plans to continue them after pandemic. Participants reported a negative impact of the pandemic on relations with coworkers (16%), relations with family (27%), their emotional and mental wellbeing (49%), research productivity (34%) and financial income (52%).
Conclusions: COVID-19 pandemic has negative effects on various personal and professional aspects of oncologists. Interventions should be implemented to mitigate the negative impact and to prepare oncologists to manage future crises with more efficiency and resilience.
Editorial acknowledgement: On behalf the International Research Network on COVID-19 Impact on Cancer Care (IRN-CICC).
Legal entity responsible for the study: The authors.
Funding: Has not received any funding. 