Quantifying the impact of the COVID-19 pandemic on gastrointestinal cancer care delivery.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 30-30
Author(s):  
Nicholas Perkons ◽  
Casey Kim ◽  
Chris Boedec ◽  
Charles John Schneider ◽  
Ursina R. Teitelbaum ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Care Delivery ◽  
Morbidity And Mortality ◽  
Specific Effects ◽  
Chemotherapy Infusion ◽  
Future Work ◽  
The Impact

30 Background: Changes in healthcare utilization and delivery during the first months of the COVID-19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies. We hypothesize this has contributed to diagnostic and treatment delays that will increase disease morbidity and mortality. Methods: We performed a retrospective cohort study comparing healthcare utilization of patients with diagnosed GI malignancy (ICD10:C15-C26) during and prior to the COVID-19 pandemic within our health system. Deidentified patient encounter parameters were collected for the first 20 weeks of both 2019 and 2020, including the number of: new patient visits (NPVs), hospital admissions, and specialty encounters. Difference-in-difference analyses adjusted for week-specific and year-specific effects quantified the impact of the COVID-19 pandemic on care delivery, with week 11 of 2020 marking the start of the pandemic period. Results: The 2019 and 2020 cohorts of patients had similar demographic compositions on the basis of sex and ethnicity (2019: n = 23,536, 56.8% M, 70.4/16.3/1.9% White/Black/Hispanic; 2020: n = 25,773, 57.0% M, 70.3/16.3/2.0% White/Black/Hispanic). Across all GI malignancies, the COVID-19 pandemic period was associated with a significant decrease in NPVs (-50.0/week, -45% from 2019, p < 1e-3). Colorectal cancer (CRC) had the largest decrease in NPVs among GI malignancies (-25.3/week, -53% from 2019, p < 1e-4). Of note, there was a parallel decrease in colonoscopies during this time (-682/week, -91% from 2019, p < 1e-11). For patients with diagnosed GI malignancies, the COVID-19 pandemic was associated with statistically significant declines in hospital admissions (-31.7/week, -37% from 2019, p < 1e-5), radiology encounters (-177/week, -38% from 2019, p < 1e-6), radiation oncology encounters (-18.2/week, -12% from 2019, p < 0.01), chemotherapy infusion visits (-62.2/week, -17% from 2019, p < 1e-4), and surgery encounters (-71.1/week, -15.7% from 2019, p < 0.01). Subgroup analyses revealed these reductions were most significant in patients with CRC (radiology encounters, surgery encounters, hospital admissions), anal cancer (radiation oncology encounters), and pancreatic cancer (chemotherapy infusion visits). Conclusions: These data demonstrate that the COVID-19 pandemic is associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC—diagnosed and managed by periodic screening—has been affected most acutely. The precipitous drop in screening colonoscopies likely contributed to the decline in NPVs, specialty encounters and hospital admissions. These findings underscore the importance of reinstating regular GI cancer screening and management. Future work will assess the impact of these and other changes to cancer care delivery on long term morbidity and mortality.

Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18609-e18609
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Sandy Srinivas ◽  
Sarah Garrigues ◽  
Eben Lloyd Rosenthal ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Advanced Practice ◽  
Curative Surgery ◽  
Time Points ◽  
Patients With Cancer ◽  
Provider Perspectives ◽  
Significant Difference ◽  
The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

scholarly journals A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

2021 ◽  
Vol 28 (4) ◽  
pp. 3201-3213
Author(s):  
Kaitlyn Howden ◽  
Camille Glidden ◽  
Razvan G. Romanescu ◽  
Andrew Hatala ◽  
Ian Scott ◽  
...  
Keyword(s):  
Young Adults ◽  
Cancer Treatment ◽  
Cancer Care ◽  
Negative Impact ◽  
Positive Impact ◽  
Care Delivery ◽  
Adolescents And Young Adults ◽  
P Value ◽  
Cross Sectional Survey ◽  
The Impact

We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of <20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value < 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.

The HOLA COVID-19 study: Evaluating the impact of caring for patients with COVID-19 on cancer care delivery in Latin America.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1537-1537
Author(s):  
Carolina Bernabe Ramirez ◽  
Ana I. Velazquez Manana ◽  
Coral Olazagasti ◽  
Cristiane Decat Bergerot ◽  
Enrique Soto Perez De Celis ◽  
...  
Keyword(s):  
Latin America ◽  
Latin American ◽  
Cancer Care ◽  
Online Survey ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Significant Proportion ◽  
Multiple Choice Questions ◽  
Patients With Cancer ◽  
The Impact

1537 Background: The severe acute respiratory syndrome 2 (SARS-cov-2) virus causing COVID-19 has brought great challenges to global health services affecting cancer care delivery, outcomes, and increasing the burden in oncology providers (OP). Our study aimed to describe the challenges that OP faced while delivering cancer care in Latin America. Methods: We conducted an international cross-sectional study using an anonymous online survey in Spanish, Portuguese, and English. The questionnaire included 43 multiple choice questions. The sample was stratified by OP who have treated patients with COVID-19 versus those who have not treated patients with COVID-19. Data was analyzed with descriptive statistics and Chi-square tests. Results: A total of 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Oncologists represented 46% of respondents, followed by 25% surgical-oncologists. Of the respondents, 56% treated patients with COVID-19. A significant proportion of OP reported newly adopting telemedicine during COVID-19 (14% vs 72%, p=0.001). More than half (58%) of OP reported making changes to the treatments they offered to patients with cancer. As shown in the table, caring for patients with COVID-19 significantly influenced practice patterns of OP. Access to specialty services and procedures was significantly reduced: 40% noted significantly decreased or no access to imaging, 20% significantly decreased or no access to biopsies, 65% reported delays in surgical oncology referrals, and 49% in radiation oncology referrals. A vast majority (82%) reported oncologic surgeries were delayed or cancelled, which was heightened among those treating patients with COVID-19 (87% vs 77%, p=0.001). Conclusions: The COVID-19 pandemic has significantly affected the way cancer care is delivered in globally. Although changes to healthcare delivery are necessary as a response to this global crisis, our study highlights the significant disruption and possible undertreatment of patients with cancer in Latin America that results from COVID-19.[Table: see text]

scholarly journals Changes in tobacco-related morbidity and mortality in French women: worrying trends

2019 ◽  
Vol 30 (2) ◽  
pp. 380-385 ◽  
Author(s):  
Valérie Olié ◽  
Anne Pasquereau ◽  
Frank A G Assogba ◽  
Pierre Arwidson ◽  
Viet Nguyen-Thanh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lung Cancer ◽  
Hospital Admissions ◽  
Population Attributable Fraction ◽  
Morbidity And Mortality ◽  
National Database ◽  
Attributable Mortality ◽  
Chronic Obstructive ◽  
Strong Impact ◽  
The Impact

Abstract Background The high prevalence of smoking among French women since the 1970s has been reflected over the past decade by a strong impact on the health of women. This paper describes age and gender differences in France of the impact of smoking on morbidity and mortality trends since the 2000s. Methods Smoking prevalence trends were based on estimates from national surveys from 1974 to 2017. Lung cancer incidence were estimated from 2002–12 cancer registry data. Morbidity data for chronic obstructive pulmonary disease (COPD) exacerbation and myocardial infarction were assessed through hospital admissions data, 2002–15. For each disease, number of deaths between 2000 and 2014 came from the national database on medical causes of death. The tobacco-attributable mortality (all causes) was obtained using a population-attributable fraction methodology. Results The incidence of lung cancer and COPD increased by 72% and 100%, respectively, among women between 2002 and 2015. For myocardial infarction before the age of 65, the incidence increased by 50% between 2002 and 2015 in women vs. 16% in men and the highest increase was observed in women of 45–64-year-olds. Mortality from lung cancer and COPD increased by 71% and 3%, respectively, among women. The estimated number of women who died as a result of smoking has more than doubled between 2000 and 2014 (7% vs. 3% of all deaths). Conclusions The increase in the prevalence of smoking among women has a major impact on the morbidity and mortality of tobacco-related diseases in women and will continue to increase for a number of years.

Quality improvement and implementation science in cancer care: Identifying areas of synergy and opportunities for further integration.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 29-29
Author(s):  
Devon Check ◽  
Leah L. Zullig ◽  
Melinda Davis ◽  
Angela M. Stover ◽  
Louise Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Implementation Science ◽  
Cancer Care ◽  
Performance Monitoring ◽  
Care Delivery ◽  
Evidence Based ◽  
Theoretical Frameworks ◽  
Randomized Design ◽  
Stakeholder Input ◽  
The Impact

29 Background: Efforts to improve cancer care delivery have been driven by two approaches: quality improvement (QI) and implementation science (IS). QI and IS have developed independently but have potential for synergy. To inform efforts to better align these fields, we examined 20 cancer-related QI and IS articles to identify differences and areas of commonality. Methods: We searched PubMed for cancer care studies that used IS or QI methods and were published in the past 5 years in one of 17 leading journals. Through consensus-based discussions, we categorized studies as QI if they evaluated efforts to improve the quality, value, or safety of care, or IS if they evaluated efforts to promote the adoption of evidence-based interventions into practice. We identified the 10 most frequently cited studies from each category (20 total studies), characterizing and comparing their objectives, methods – including use of theoretical frameworks involvement of stakeholders – and terminology. Results: All IS studies (10/10) and half (5/10) of QI studies addressed barriers to uptake of evidence-based practices. The remaining five QI studies sought to improve clinical outcomes, reduce costs, and/or address logistical issues. QI and IS studies employed common approaches to change provider and/or organizational practice (e.g., training, performance monitoring/feedback, decision support). However, the terminology used to describe these approaches was inconsistent within and between IS and QI studies. Fewer than half (8/20) of studies (4 from each category) used a theoretical or conceptual framework and only 4/20 (2 from each category) consulted key stakeholders in developing their approach. Most studies (10/10 IS and 6/10 QI) were multi-site, and most were observational, with only 4/20 studies (2 from each category) using a randomized design to evaluate their approach. Conclusions: Cancer-related QI and IS studies had overlapping objectives and used similar approaches but used inconsistent terminology. The impact of IS and QI on cancer care delivery could be enhanced by greater harmonization of language and by promoting rigor through the use of conceptual frameworks and stakeholder input.

Using implementation science to examine impact of a social responsibility agenda on addressing cancer health disparities in Ceará, Brazil.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19071-e19071
Author(s):  
Hermano Alexandre Lima Rocha ◽  
Irene Dankwa-Mullan ◽  
Pedro Meneleu ◽  
Caio Figueiredo Juaçaba ◽  
Metasebya Solomon ◽  
...  
Keyword(s):  
Social Responsibility ◽  
Implementation Science ◽  
Cancer Care ◽  
Process Model ◽  
Care Delivery ◽  
Clinical Care ◽  
Evaluation Framework ◽  
Northeastern Brazil ◽  
Longitudinal Impact ◽  
The Impact

e19071 Background: Programs to address disparities in cancer care outcomes in resource-limited settings require attention to social determinants of health (SDoH) to achieve successful clinical care implementation. The Instituto de Câncer do Ceará, the largest cancer center in northeastern Brazil, has implemented a Social Responsibility Agenda (SRA) to guide equitable cancer care delivery. This goal of this study was to develop a framework for an implementation science (IS) study evaluating the longitudinal impact of the SRA on cancer outcomes. Methods: We outlined a mixed-methods and participatory study incorporating a process model, the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework. A list of constructs and links to measurement tools associated with IS models were identified to guide the study phases. Results: We established a logic model to guide in evaluating the health and economic impact of the SRA. We identified >30 constructs and measures across domains of IS models. The table shows a driver diagram to inform the framework. Conclusions: Understanding determinants, key drivers and change concepts are important initial steps in an ongoing evaluation of the impact of evidence based SDoH interventions to address cancer disparities. [Table: see text]

scholarly journals Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic

2016 ◽  
Vol 12 (3) ◽  
pp. e320-e331 ◽  
Author(s):  
Ryan Y.C. Tan ◽  
Marie Met-Domestici ◽  
Ke Zhou ◽  
Alexis B. Guzman ◽  
Soon Thye Lim ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cancer Care ◽  
Cancer Genetics ◽  
Care Delivery ◽  
Genetic Counselor ◽  
Activity Based Costing ◽  
Improvement Project ◽  
Personnel Costs ◽  
Number Of Patients ◽  
The Impact

Purpose: To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Methods: Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Results: Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. Conclusion: This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.

scholarly journals Outpatient Care

2021 ◽  
pp. 21-33
Author(s):  
Ian Qianhuang Wu ◽  
Francesca Lorraine Wei Inng Lim ◽  
Liang Piu Koh
Keyword(s):  
T Cell ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Care Delivery ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Cancer Center ◽  
T Cell Therapy ◽  
Car T Cell Therapy ◽  
Near Future

AbstractManagement of haematology-oncology patients has historically been largely inpatient-based. With advances in the understanding of disease and improvements in supportive care, patients are increasingly being managed in the outpatient setting. This is especially evident in autologous stem cell transplantation, which is now routinely done as an outpatient procedure at various centres. As clinicians gain more experience in novel therapies such as chimeric antigen receptor (CAR)-T cell therapy and bispecific T cell engager (BiTE) therapy, these may potentially be administered in the outpatient setting in the near future with the adoption of a risk-stratified approach. Such a paradigm shift in the practice of haematology-oncology is inevitable and has been driven by several factors, including pressure from the institution/hospital to avoid unnecessary hospital admissions and for optimal use of inpatient resources to be more cost-effective and efficient. With favourable local regulations and funding, outpatient cancer care can be economically beneficial. The success of an outpatient cancer center is heavily dependent on planning the facility to be equipped with the appropriate infrastructure, together with the trained medical and supportive personnel in place. This, coupled with the utilization of emerging technology such as telemedicine, has the potential to revolutionize cancer care delivery in the outpatient setting.

scholarly journals Spotlight on International Quality: COVID-19 and Its Impact on Quality Improvement in Cancer Care

2021 ◽  
pp. 1513-1521
Author(s):  
Douglas W. Blayney ◽  
Giovanni Bariani ◽  
Devika Das ◽  
Shaheenah Dawood ◽  
Michael Gnant ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
United Arab Emirates ◽  
Health Care Providers ◽  
Cancer Care ◽  
Care Delivery ◽  
Global Scale ◽  
The Philippines ◽  
Care Providers ◽  
The Impact

This report from ASCO's International Quality Steering Group summarizes early learnings on how the COVID-19 pandemic and its stresses have disproportionately affected cancer care delivery and its delivery systems across the world. This article shares perspectives from eight different countries, including Austria, Brazil, Ghana, Honduras, Ireland, the Philippines, South Africa, and the United Arab Emirates, which provide insight to their unique issues, challenges, and barriers to quality improvement in cancer care during the pandemic. These perspectives shed light on some key recommendations applicable on a global scale and focus on access to care, importance of expanding and developing new treatments for both COVID-19 and cancer, access to telemedicine, collecting and using COVID-19 and cancer registry data, establishing measures and guidelines to further enhance quality of care, and expanding communication among governments, health care systems, and health care providers. The impact of the COVID-19 pandemic on cancer care and quality improvement has been and will continue to be felt across the globe, but this report aims to share these experiences and learnings and to assist ASCO's international members and our global fight against the pandemic and cancer.

scholarly journals 787Multistate modelling to investigate the impact of recurrent malaria episodes on hospital admissions and mortality

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Saber Dini ◽  
Nicholas Douglas ◽  
Jeanne Rini Poespoprodjo ◽  
Enny Kenangalem ◽  
Paulus Sugiarto ◽  
...  
Keyword(s):  
Vivax Malaria ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Early Death ◽  
Morbidity And Mortality ◽  
Radical Cure ◽  
Liver Stage ◽  
Recurrent Malaria ◽  
The Impact ◽  
Malaria Episodes

Abstract Background Inadequate prevention and treatment of malaria can lead to reinfections and recurrent episodes, and for vivax malaria, further recurrences from the dormant liver stage. This study quantified the impact of recurrent malaria episodes on morbidity and mortality. Methods Routinely collected data were available from 68,381 malaria patients presenting to the primary referral hospital in Papua, Indonesia. A multi-state modelling framework, with Cox regression for transition rates, was employed to determine the risks of re-presentation to hospital, receiving in-patient treatment, and early (≤14 days post treatment)/late death following multiple malaria episodes. Results The risk of re-presentation to hospital increased from 34.7% (95%CI: 34.4%–35.1%) at first episode to 58.6% (57.5%–59.6%) following the third episode. Infection with vivax malaria increased the rate of re-presentation to hospital by 1.48-fold (Hazard Ratio 1.48; 95%CI 1.44–1.51) and late hospital in-patient admission by 1.17-fold (1.11–1.22), compared to falciparum. Falciparum malaria caused a higher overall rate of early death (1.54 (1.25–1.92)), however, after multiple episodes, there was a trend towards a greater rate of early death for vivax infection (1.91 (0.73–4.97)). Conclusions Recurrent episodes of malaria can cause substantial morbidity and mortality, highlighting the importance of prevention and effective treatments for both falciparum and vivax malaria. Key messages To achieve elimination of malaria in South-East Asia, where prevalence of vivax malaria is high, we must prioritise the radical cure of vivax to eliminate the liver-stage of this species that causes relapses of infection.

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