scholarly journals Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vivek Nimgaonkar ◽  
Charu Aggarwal ◽  
Abigail T. Berman ◽  
Peter Gabriel ◽  
Lawrence N. Shulman ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Treatment Initiation ◽  
Office Visit ◽  
Initial Visit ◽  
Time To Treatment ◽  
Safe Delivery ◽  
Time To Treatment Initiation ◽  
New Diagnosis ◽  
Thoracic Malignancies ◽  
The Impact

Abstract Background To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. Methods This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. Results 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). Conclusions Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.

scholarly journals The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying – the head and neck cancer model

2020 ◽  
Author(s):  
Leandro L. Matos ◽  
Carlos Henrique Q. Forster ◽  
Gustavo N. Marta ◽  
Gilberto Castro Junior ◽  
John A. Ridge ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Treatment Initiation ◽  
Additional Risk ◽  
Time To Treatment ◽  
Time To Treatment Initiation ◽  
Risk Of Cancer ◽  
The Impact

Abstract Purpose: The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time to treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. Methods: An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. Results: The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time to treatment initiation. Conclusions: This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.

Impact of time to treatment initiation on real-world (RW) outcomes in metastatic pancreatic cancer (mPC) in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16254-e16254
Author(s):  
Olumide B. Gbolahan ◽  
Darryl Alan Outlaw ◽  
Neda Hashemi ◽  
Ravi Kumar Paluri ◽  
Grant Richard Williams
Keyword(s):  
Systemic Therapy ◽  
Treatment Initiation ◽  
Multinomial Logistic Regression ◽  
Clinical Factors ◽  
First Line ◽  
Line Therapy ◽  
Significant Difference ◽  
Time To Treatment Initiation ◽  
The Impact ◽  
To Receive

e16254 Background: The COVID-19 pandemic caused disruptions in cancer care delivery and forced oncologists to make recommendations about safely delaying initiation of cancer therapy. Compared to the adjuvant, curative setting, there is a scarcity of information about the impact of time to treatment initiation on outcomes in the palliative setting for gastrointestinal malignancies. We sought to determine the median time to initiation of systemic therapy (TIT) in mPC in the US pre-pandemic, and to assess the impact of TIT on survival outcomes. Methods: We retrospectively analyzed de-identified data of patients with mPC in the Flatiron Health nationwide EHR-derived database. Metastatic diagnosis dates between 01/2014 and 04/2020 were included. Demographics, treatments, and outcomes were collected. TIT was defined as period between diagnosis and initiation of first-line systemic therapy and was split into 3 categories (I: < 2 weeks, II: 2- <4 weeks, and III: 4-8 weeks). Overall survival (OS) was defined from time of diagnosis to time of death. Post-chemotherapy survival (PCS) was time from initiation of first-line therapy to death. Adjusted and unadjusted multinomial logistic regression were used to evaluate the association of demographics and clinical factors with TIT. PCS and OS were estimated with Kaplan-Meier curves. Adjusted (demographics and clinical factors) Cox proportional hazard models were used to estimate the effect of TIT groups on PCS and OS. Category II served as control group. Results: 3231 patients with mPC who received at least one line of treatment were identified. 29% (N= 947), 43% (N=1375), and 28% (N= 909) were in TIT categories I-III respectively. The mean age at diagnosis was 67.4 years, with no significant difference in age (P=0.14) among categories. Median TIT was 20 days. Multinomial logistic regression showed that compared to TIT II, Black patients were less likely than White patients to receive chemotherapy in less than 2 weeks (P=0.02), and those who had recurrent disease were more likely to receive therapy in less than 2 weeks (P< 0.0001). There was no significant difference in median RW OS among the groups (I: 8.13, II: 8.07, III: 9.02 months, P=0.0532). RW PCS was also similar across categories (I: 7.8, II: 7.5, III: 7.8 months, P=0.88). Adjusted cox regression analysis suggests that compared to TIT of 2-4 weeks, TIT 4-8 weeks was associated with higher RW OS (HR, 0.88, 95% CI 0.8-0.97, P=0.009), but not RW PCS (HR, 0.95, 95% CI 0.87-1.05, P=0.32). Conclusions: This real-world analysis suggests that pre-pandemic, most patients with mPC who receive 1st line therapy were treated within 4 weeks of diagnosis. Compared to TIT of 2-4 weeks, TIT 4-8 weeks was associated with higher RW OS in mPC, although the clinical significance is minimal. In crisis situations, efforts to clinically optimize patients with mPC before systemic therapy should continue to be pursued.

scholarly journals Time to Treatment Initiation for Breast Cancer During the 2020 COVID-19 Pandemic

2021 ◽  
pp. OP.20.00807
Author(s):  
Kathryn Hawrot ◽  
Lawrence N. Shulman ◽  
Ira J. Bleiweiss ◽  
Elizabeth J. Wilkie ◽  
Zachary A. K. Frosch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Treatment Initiation ◽  
Patient Volume ◽  
Newly Diagnosed ◽  
Time To Treatment ◽  
Academic Center ◽  
Time To Treatment Initiation ◽  
The Impact

PURPOSE: The COVID-19 pandemic has posed significant pressures on healthcare systems, raising concern that related care delays will result in excess cancer-related deaths. Because data regarding the impact on patients with breast cancer are urgently needed, we aimed to provide a preliminary estimate of the impact of COVID-19 on time to treatment initiation (TTI) for patients newly diagnosed with breast cancer cared for at a large academic center. METHODS: We conducted a retrospective study of patients with newly diagnosed early-stage breast cancer between January 1, 2020, and May 15, 2020, a time period during which care was affected by COVID-19, and an unaffected cohort diagnosed between January 1, 2018 and May 15, 2018. Outcomes included patient volume, TTI, and initial treatment modality. Adjusted TTI was compared using multivariable linear regression. RESULTS: Three hundred sixty-six patients were included. There was an 18.8% decrease in patient volume in 2020 (n = 164) versus 2018 (n = 202). There was no association between time of diagnosis (pre-COVID-19 or during COVID-19) and adjusted TTI ( P = .926). There were fewer in situ diagnoses in the 2020 cohort ( P = .040). There was increased use of preoperative systemic therapy in 2020 (43.9% overall, 20.7% chemotherapy, and 23.2% hormonal therapy) versus 2018 (16.4% overall, 12.4% chemotherapy, and 4.0% hormonal therapy) ( P < .001). CONCLUSION: TTI was maintained among patients diagnosed and treated for breast cancer during the COVID-19 pandemic at a single large academic center. There was a decrease in patient volume, specifically in patients with in situ disease and a shift in initial therapy toward the use of preoperative hormonal therapy.

Impact of Time from Diagnosis to Initiation of Curative-Intent Chemotherapy on Clinical Outcomes in Patients with Hodgkin Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4237-4237
Author(s):  
Edward G. Brooks ◽  
Joseph M. Connors ◽  
Laurie H. Sehn ◽  
Randy D. Gascoyne ◽  
Kerry J. Savage ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Clinical Outcomes ◽  
Treatment Initiation ◽  
Performance Status ◽  
Treatment Delay ◽  
Curative Intent ◽  
Time To Treatment ◽  
Cancer Agency ◽  
Time To Treatment Initiation ◽  
The Impact

Abstract Introduction Hodgkin lymphoma is a highly curable lymphoid malignancy when treated with multi-agent chemotherapy regimens such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). The optimal timing of curative intent chemotherapy and the impact of treatment delay on clinical outcomes in Hodgkin lymphoma are currently unknown. Patients and Methods Adult patients diagnosed with Hodgkin lymphoma in British Columbia (BC) between January 1999 and December 2010 were identified in the BC Cancer Agency Centre for Lymphoid Cancer Database. Patients were included if they received at least one cycle of ABVD with curative intent. Patients treated with regimens other than ABVD and those treated with palliative intent were excluded. Additional demographic data were obtained from the BC Cancer Registry. Chemotherapy administration data, including drugs, dates administered, and treatment center, were obtained from the BC Cancer Agency provincial pharmacy database. Time to treatment initiation was defined as the time between the date of definitive histological confirmation of Hodgkin lymphoma and date of the first dose of ABVD. We then evaluated the effect of time to treatment initiation on overall survival (OS) and progression-free survival (PFS) at 5 years. Results A total of 879 patients were identified: 110 (13%) received ABVD within 2 weeks of diagnosis, 260 (30%) within 3 – 4 weeks, 405 (46%) within 5 – 8 weeks, and 104 (12%) beyond 8 weeks. Inpatient chemotherapy, elevated LDH, poor performance status, advanced stage, B symptoms, and bulky disease were all associated with treatment initiation within 2 weeks (p<0.01 for all factors). Age >45 and nodular lymphocyte predominant histology were significantly associated with treatment initiation >8 weeks (p<0.01 for all factors). Residence in a rural location at the time of diagnosis or the need to travel more than 200 km in order to receive initial chemotherapy were not associated with time to treatment (P = 0.26 and P = 0.90, respectively). Reasons for treatment initiation >8 weeks included systematic delays in the process of referral, staging, and scheduling of treatment (n=66), uncontrolled comorbidities (n=13), patient refusal of earlier treatment (n=9), pregnancy (n=5), revised pathological diagnosis (n=4), unknown cause of delay (n=4), and social or substance abuse factors (n=3). With a median follow-up of 5.6 years (range 1 month – 14 years) in living patients, the 5-year OS estimates were 90% (standard error (SE) 3%) for time to treatment<2 weeks, 93% (SE 2%) for 3-4 weeks, 92% (SE 1%) for 5-8 weeks, and 84% (SE 4%) for >8 weeks (P = 0.012). Five-year PFS estimates were 82% (SE 4%) for time to treatment<2 weeks, 79% (SE 3%) for 3-4 weeks, 86% (SE 2%) for 5-8 weeks, and 84% (SE 4%) for >8 weeks (P = 0.198). In multivariate analysis, age, gender, performance status, stage, and time to treatment were significantly associated with OS, while only age and stage were significantly associated with PFS. Conclusions In a publicly funded healthcare system with universal access to cancer treatment and standardized diagnostic review, initiation of ABVD beyond 8 weeks appears to be associated with worse OS but not PFS. Reasons for treatment delay in this group are heterogeneous and may be responsible for the detrimental effect on OS. Nonetheless, clinicians should make every effort possible to initiate curative-intent chemotherapy as soon as a diagnosis of Hodgkin lymphoma is established. Disclosures: No relevant conflicts of interest to declare.

BRAF testing timelines and impact on the starting of systemic treatment.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21575-e21575
Author(s):  
Diana Paola Arteaga ◽  
Zaid Saeed Kamil ◽  
Thiago Pimentel Muniz ◽  
Diane Liu ◽  
Ian King ◽  
...  
Keyword(s):  
Median Time ◽  
Systemic Therapy ◽  
Treatment Initiation ◽  
Medical Oncology ◽  
Stage Iv ◽  
Turnaround Time ◽  
Braf V600e ◽  
Time To Treatment ◽  
Stage Iv Disease ◽  
Time To Treatment Initiation

e21575 Background: Targeted therapy with BRAF and MEK inhibitors constitute part of the standard treatment for BRAF V600 mutated melanoma. Timely detection of BRAF mutation is necessary for clinicians and patients to make treatment decisions. We aimed to map the BRAF testing timelines from the time of request until the reported result in order to assess obstacles to timely BRAF reporting in our community, and its impact on the initiation of systemic therapy. Methods: In this single-center retrospective study, we included adult patients referred to the Medical Oncology Department at the Princess Margaret Cancer Centre (PM) from January 2019 to August 2019 with histologically confirmed cutaneous or mucosal melanoma and BRAF molecular testing performed in 2019. The Log-Rank method was applied to detect differences in BRAF turnaround time and time to treatment initiation in specified subgroups. A p value < 0.05 was considered statistically significant. Results: Sixty-six cases were identified. The median age was 64 (24-88), and 42 (64%) were male. At the time of BRAF request, 10 (15%) patients had stage II, 33 (50%) had stage III, and 23 (35%) had stage IV disease. Twenty-eight (43%) were positive for the BRAF V600E/K mutation by ARMS assay and 4 (6%) for other variants by NGS test. Thirty-three (50%) patients had the BRAF test available at their first PM Medical Oncology visit. Median time between BRAF request and result was 17 days; when a reflex BRAF test was ordered by the Pathology Department, the median turnaround time was 12 days (95% CI 8-15), compared to 20 days (95% CI 16-23) if the order was requested by another specialist ( p < 0.001). Median time to transfer samples between institutions was 6 days. If the BRAF test was processed within the institution where the biopsy was performed, the BRAF median turnaround time was 13 days (95% CI 6-19) compared to 19 days (95% CI 16-21) if a sample was transferred to another institution ( p = 0.02). In total, 49 patients had systemic therapy. Median time between the first visit with Medical Oncology and treatment initiation was 29 days and was not statistically different if the BRAF result was available or not (28 vs. 34 days; p = 0.09). In the subgroup with stage IV disease (Table), 20 patients received systemic therapy; the median time to treatment initiation was 24 days and differed with BRAF result availability (20 vs. 31 days, p = 0.03). Conclusions: The current BRAF testing timeline at the PM varies from days to weeks. A major factor impacting this timeline is transfer time, which can be streamlined by pathology reflex testing. Delays in turnaround time appears to impact subsequent timing and type of therapeutic interventions, especially in patients with stage IV disease.[Table: see text]

The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy

Oral Oncology ◽  
2017 ◽  
Vol 67 ◽  
pp. 175-182 ◽  
Author(s):  
Jerry Polesel ◽  
Carlo Furlan ◽  
Silvia Birri ◽  
Vittorio Giacomarra ◽  
Emanuela Vaccher ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Initiation ◽  
Time To Treatment ◽  
North Eastern ◽  
Time To Treatment Initiation ◽  
The Impact

scholarly journals The impact of changes in HIV management guidelines on time to treatment initiation in Australia

HIV Medicine ◽  
2017 ◽  
Vol 18 (9) ◽  
pp. 701-703 ◽  
Author(s):  
R Puhr ◽  
K Petoumenos ◽  
D Youds ◽  
MG Law ◽  
DJ Templeton ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Management Guidelines ◽  
Time To Treatment ◽  
Hiv Management ◽  
Time To Treatment Initiation ◽  
The Impact

scholarly journals Comparative outcomes in patients receiving pirfenidone or nintedanib for idiopathic pulmonary fibrosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Manon Belhassen ◽  
Faustine Dalon ◽  
Maëva Nolin ◽  
Eric Van Ganse
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Treatment Initiation ◽  
Proportional Hazards Model ◽  
Research Question ◽  
National Health System ◽  
Cox Proportional Hazards Model ◽  
Time To Treatment ◽  
All Cause Mortality ◽  
Time To Treatment Initiation

Abstract Background Real-world data regarding outcomes of idiopathic pulmonary fibrosis (IPF) are scarce, outside of registries. In France, pirfenidone and nintedanib are only reimbursed for documented IPF, with similar reimbursement criteria with respect to disease characteristics, prescription through a dedicated form, and IPF diagnosis established in multidisciplinary discussion. Research question The data of the comprehensive French National Health System were used to evaluate outcomes in patients newly treated with pirfenidone or nintedanib in 2015–2016. Study design and methods Patients aged < 50 years or who had pulmonary fibrosis secondary to an identified cause were excluded. All-cause mortality, acute respiratory-related hospitalisations and treatment discontinuations up to 31 December 2017 were compared using a Cox proportional hazards model adjusted for age, sex, year of treatment initiation, time to treatment initiation and proxies of disease severity identified during a pre-treatment period. Results During the study period, a treatment with pirfenidone or nintedanib was newly initiated in 804 and 509 patients, respectively. No difference was found between groups for age, sex, time to treatment initiation, Charlson comorbidity score, and number of hospitalisations or medical contacts prior to treatment initiation. As compared to pirfenidone, nintedanib was associated with a greater risk of all-cause mortality (hazard ratio [HR], 1.8; 95% confidence interval [CI] 1.3–2.6), a greater risk of acute respiratory-related hospitalisations (HR 1.3; 95% CI 1.0–1.7) and a lower risk of treatment discontinuation at 12 months (HR 0.7; 95% CI 0.6–0.9). Interpretation This observational study identified potential differences in outcome under newly prescribed antifibrotic drugs, deserving further explorations.

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