Differences in the Impact of COVID-19 on Pathology Laboratories and Cancer Diagnosis in Girona

Introduction: The recent COVID-19 pandemic has compromised socio-health care, with consequences for the diagnosis and follow-up of other pathologies. The aim of this study was to evaluate the impact of COVID-19 on cancer diagnosis in Girona, Spain. Methodology: Observational study of samples received in two pathology laboratories during 2019–2020 (tertiary hospital in Girona and county hospital in Figueres). Date, sample type, and location and morphology were available. Samples were recoded to determine malignancy and grouped by location. Comparisons were made by calendar year and period of exposure to COVID-19. Results: 102,360 samples were included: 80,517 from Girona and 21,843 from Figueres. The reduction in activity in the pathology laboratories in 2020 compared to the previous year was 25.4% in Girona and 27.5% in Figueres. The reduction in cancer diagnoses in 2020 compared to 2019 was 6.8% in Girona and 21% in Figueres. In both laboratories, a decrease was observed in the diagnoses of neoplasms of the lip, oral cavity and pharynx, larynx, colon, rectum and anus, kidney and urinary system, melanoma, and central nervous system. A statistically significant higher probability of a sample received in the pathology laboratory displaying malignancy during COVID-19 was found (Girona: OR = 1.28, 95% CI: 1.23–1.34; Figueres: OR = 1.10, 95% CI: 1.01–1.20) with respect to the COVID-19-free period. Conclusions: The COVID-19 pandemic has resulted in a reduction in cancer diagnoses by pathology departments that varies according to tumor location and type of hospital. Despite this, the optimization of care resources and the recovery effort have partially reduced the impact of the pandemic in certain neoplasms.

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Venous and Lung Thromboembolism in the Context of Lung Cancer: Clinical Manifestations, Risk Factors and Prognosis

Acta Médica Portuguesa ◽

10.20344/amp.10260 ◽

2019 ◽

Vol 32 (10) ◽

pp. 647 ◽

Cited By ~ 1

Author(s):

Rosana Maia ◽

Inês Neves ◽

António Morais ◽

Henrique Queiroga

Keyword(s):

Lung Cancer ◽

Venous Thromboembolism ◽

Cancer Diagnosis ◽

Negative Impact ◽

Clinical Manifestations ◽

Research Subjects ◽

Lung Cancer Diagnosis ◽

The Impact ◽

The Relationship

Introduction: The relationship between cancer and thromboembolic events has been known for a long time. Lung and venous thromboembolism are frequent complications of lung cancer and its treatment, being a great cause of morbidity and mortality. We pretend to establish the relationship between lung and venous thromboembolism and lung cancer, describe patient characteristics and analyze the impact in the survival and prognosis.Material and Methods: It was a retrospective study. All research subjects were selected from lung cancer patients with a newly diagnosed lung and venous thromboembolism event admitted to Hospital S. João, between January 2008 and December 2013 and were followed until December 2014. Statistical analysis was performed with SPSS.Results: From the search, we obtained 113 patients. The majority was male, smokers or ex-smokers, and adenocarcinoma was the most frequent histologic type, being diagnosed mostly in advanced stages. We noticed that the median time between lung cancer diagnosis and lung venous thromboembolism was 2.9 months. In 24 patients (21.4%), the lung cancer diagnosis occurred after the lung and venous thromboembolism event and in 86 patients (76.8%), it occurred before the event. After a median follow up of 1.4 months, 107 (94.7%) patients died, 1 (0.9%) was lost to follow-up and 5 (4.4%) were still alive. The median survival rate was 1.5 months.Discussion: The diagnosis of lung and venous thromboembolism in patients with lung cancer is associated with bad prognosis. It occurs most frequently in patients with advanced disease, in the first months after lung cancer diagnosis and after beginning chemotherapy.Conclusion: Disease progression is an independent predictor with negative impact in overall survival.

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Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results

Einstein (São Paulo) ◽

10.1590/s1679-45082018ao4112 ◽

2018 ◽

Vol 16 (2) ◽

Author(s):

Ana Carolina de Souza e Silva ◽

Domingos Sávio de Carvalho Sousa ◽

Eunice Bobô de Carvalho Perraud ◽

Fátima Rosane de Almeida Oliveira ◽

Bruna Cristina Cardoso Martins

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Pharmacist ◽

Anatomical Therapeutic Chemical ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Cross Sectional ◽

Respiratory Intensive Care Unit ◽

The Impact

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

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Survival of breast cancer patients receiving adjunctive psychosocial support therapy: a 10-year follow-up study.

Journal of Clinical Oncology ◽

10.1200/jco.1993.11.1.66 ◽

1993 ◽

Vol 11 (1) ◽

pp. 66-69 ◽

Cited By ~ 82

Author(s):

G A Gellert ◽

R M Maxwell ◽

B S Siegel

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Survival Time ◽

Cancer Diagnosis ◽

Psychosocial Support ◽

Support Program ◽

Breast Cancer Patients ◽

Nonsignificant Difference ◽

The Impact

PURPOSE The impact of an adjunctive psychosocial support program on length of survival with breast cancer was evaluated in a retrospective cohort study. The duration of observation of survival was extended 10 years beyond a previous study of the same cohort of patients. PATIENTS AND METHODS One hundred two nonparticipants were individually matched to 34 participants on major prognostic factors. Both groups were monitored from the date of cancer diagnosis (1971 through 1980) until March 1991. The support program consisted of weekly cancer peer support and family therapy, individual counseling, and use of positive mental imagery. Survival analysis controlled for the effects of other major prognostic factors in the outcome of breast cancer. RESULTS The mean +/- SD survival time from date of cancer diagnosis to last date of follow-up was 96.0 +/- 53.2 months in the participant group compared with 85.1 +/- 63.4 months in the nonparticipant group, a nonsignificant difference (P = .1). Median survival was 84.0 months for participants (95% confidence interval [CI], 59 to 133) and 66.0 months for nonparticipants (95% CI, 48 to 105). A second analysis restricted nonparticipants to those who had a survival time > or = that of the matched case at time of entry into the support program. Survival increased to a mean of 101.1 months (median, 105.0; 95% CI, 71 to 132) for nonparticipants and remained unchanged for participants, also a statistically nonsignificant difference (P = .9). CONCLUSION While the program may have beneficial effects on quality of life, this study does not indicate a significant favorable impact on survival with breast cancer or that the program is serving as a social locus for the gathering of exceptional survivors.

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Assessment of the treatment results in patients with breast cancer coexisting with pregnancy: A single-center observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12566 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12566-e12566

Author(s):

Anna Skrzypczyk-Ostaszewicz ◽

Agnieszka I. Jagiello-Gruszfeld ◽

Jerzy Giermek ◽

Zbigniew Nowecki

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Diagnosis ◽

Disease Free Survival ◽

Breast Cancer Diagnosis ◽

Diagnosis And Treatment ◽

Free Survival ◽

The Impact ◽

Disease Free

e12566 Background: This study discusses the analysis of the prospectively collected material on pregnant patients treated for breast cancer at the Department of Breast Cancer and Reconstructive Surgery of the Maria Skłodowska-Curie National Oncology Institute - National Research Institute (until 2020: Oncology Center - Institute) in Warsaw, in the years 1995 - 2020. 84 patients were included into the final analysis and 72 children were assessed simultaneously. Methods: The paper summarizes information on the diagnosis and treatment of breast cancer during pregnancy, the course of pregnancy and childbirth and the birth parameters of children i.e. weight, length and Apgar score, as well as the dependencies between them, mainly the impact of some breast cancer, diagnosis and treatment process features on the newborns. The patietnt’s survavial - DFS ( disease free survival) and OS ( overall survival) - was also analyzed. The course of breast cancer diagnosis and treatment data were obtained from the patients’ medical documentation (medical records) and from information provided by the mothers during follow-up visits and read in the children's health books. In order to answer the research questions, statistical analyzes were conducted using the IBM SPSS Statistics 26 package. Results: In the analyzed period, the disease recurrence was recognized in 34 (40.5%) patients, and 24 (28.6%) patients died. The median disease-free survival (DFS) was 12.3 years (147.5 months), and the median overall survival (OS) was not reached during the follow-up period. The estimated 5-year survival rates for DFS and OS were 57.9% and 74.5% respectively, and for 10-year survival - 51.4% and 64.5%. The study showed a statistically significant relationship between the baseline clinical advancement and DFS. It has been also analyzed how the diagnosis, treatment and method of pregnancy termination changed in two time periods (1995-2012 and 2013-2020). There were no statistically significant differences in survival - both DFS and OS - between the group of patients treated before and after 2012. In the assessment of the impact of some factors on the birth children parameters (weight and length), statistically significant results were obtained for: pregnancy advancement at diagnosis, breast cancer stage at diagnosis, pregnancy advancement at the start of chemotherapy, the chemotherapy regimen (classic or dose-dense), the number of cycles of chemotherapy given during pregnancy, and the number of drugs used in supportive treatment. Conclusions: The entire analysis has become not only an insightful characteristic of the studied group, but also these results may be important in everyday clinical practice and may help to optimize the management of an extremely complex and difficult situation, which is the coexistence of pregnancy with a malignant disease that threatens the mother’s life.

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Effects of the Timing and the Type of Venous Thromboembolic Events On Survival in Patients with Pancreatic Cancer

Blood ◽

10.1182/blood.v120.21.1151.1151 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1151-1151

Author(s):

Vivek Kesari ◽

Maithili Shethia ◽

Xiao Zhou ◽

Michael Overman ◽

Saroj Vadhan-Raj

Keyword(s):

Pancreatic Cancer ◽

Survival Analysis ◽

Cancer Diagnosis ◽

Thromboembolic Events ◽

Kaplan Meier ◽

Compression Ultrasound ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

The Impact

Abstract Abstract 1151 Background: Patients (pts) with pancreatic cancer are at high risk for venous thromboembolic events (VTE) and the occurrence of VTE can adversely affect prognosis. However, it is unclear if the type of VTE such as symptomatic vs incidental, deep vein thrombosis (DVT) vs pulmonary embolism (PE), the location of VTE [DVT of extremities vs visceral veins (abdominal/pelvic veins)] or the timing of VTE from diagnosis can influence the survival. The purpose of this study was to evaluate the incidence of different types of VTE, the impact of types and timing of VTE (early vs late) on survival. Methods: Medical records of 260 pts with pancreatic cancer, newly referred to MDACC in 2006, were reviewed for cancer diagnosis, patient demographics (age, gender), presence of metastasis, the date of diagnosis of VTE, timing of VTE, type of VTE, the site of VTE, the incidence of VTE during 2 years of follow up from the date of diagnosis. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was calculated from the date of cancer diagnosis to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results: Of the 260 pts referred, 235 were confirmed to have the diagnosis of pancreatic carcinoma. During the 2-year follow-up, 80 pts (34%) had 109 episodes of VTE, including symptomatic and incidental episodes. The median age of the pts with VTE was 59 years (range: 28–86) and 51% were males. Of the 80 pts with VTE, 21 (26%) had PE, 18 (23%) had DVT of extremities, 28 (35%) had DVT of visceral veins and 13 (16%) had concurrent PE/DVT (diagnosed on the same day). Of the 80 pts, 25 (31%) had 29 recurrent episodes. Kaplan-Meier survival analysis, as shown in the table below, indicated that the pts who had early VTE (defined as VTE diagnosed within 30 days from the date of diagnosis of pancreatic cancer) vs late VTE (> 30 days) and pts with metastasis vs no metastasis had statistically poor 1 year survival (log-rank test). Conclusions: These findings suggest that timing of VTE is an important indicator of prognosis, regardless of whether symptomatic or incidental. Patients with VTE within 30 days of diagnosis have shorter survival. Disclosures: No relevant conflicts of interest to declare.

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Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology

Australian Health Review ◽

10.1071/ah090549 ◽

2009 ◽

Vol 33 (4) ◽

pp. 549 ◽

Cited By ~ 50

Author(s):

Kate P Taylor ◽

Sandra C Thompson ◽

Marianne M Wood ◽

Mohammed Ali ◽

Lyn Dimer

Keyword(s):

Health Worker ◽

Hospital Setting ◽

Aboriginal Health ◽

Hospital Staff ◽

Tertiary Hospital ◽

Culturally Appropriate Care ◽

Job Role ◽

The Impact ◽

Aboriginal Health Worker

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting.

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Bootstrapping disaster: The challenge of growing and maintaining a cross-sector collaborative network

Journal of Emergency Management ◽

10.5055/jem.2016.0304 ◽

2016 ◽

Vol 14 (6) ◽

pp. 397 ◽

Cited By ~ 1

Author(s):

Aaron Wachhaus, PhD

Keyword(s):

Network Analysis ◽

Nonprofit Organizations ◽

Community Response ◽

Intersectoral Collaboration ◽

Hurricane Irene ◽

Response And Recovery ◽

Recovery Effort ◽

Private Actors ◽

The Impact

This article examines the interaction of nonprofit and private actors with the traditional bureaucratic structures of government in central Pennsylvania's recovery from hurricane Irene and tropical storm Lee. That effort relied heavily on private and nonprofit organizations as drivers of the response and recovery. The author maps the organizations involved in the recovery effort and explores the impact of the recovery effort on those organizations. A social network analysis was conducted and complemented with follow-up interviews with key actors. The network analysis reveals weak communication between sectors and a reliance on nonprofits to deliver services; interviews uncover the challenges of intersectoral collaboration. The author addresses the successes and limitations of the means by which a network of nonprofit efforts were coordinated with federal and state relief efforts and draw lessons for improving future practices. The author finds that this case deviates from theory in several ways that complicated community response and recovery. In particular, the challenges of developing and maintaining a recovery network while simultaneously delivering services placed great strain on several organizations, as well as on the fledgling network as a whole.

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Causes of Death and Relative Survival of Older Women After a Breast Cancer Diagnosis

Journal of Clinical Oncology ◽

10.1200/jco.2010.33.0472 ◽

2011 ◽

Vol 29 (12) ◽

pp. 1570-1577 ◽

Cited By ~ 80

Author(s):

Mara A. Schonberg ◽

Edward R. Marcantonio ◽

Long Ngo ◽

Donglin Li ◽

Rebecca A. Silliman ◽

...

Keyword(s):

Breast Cancer ◽

Older Women ◽

Cancer Diagnosis ◽

Breast Cancer Diagnosis ◽

Stage I ◽

Stage Ii ◽

Mortality Data ◽

Data Set ◽

The Impact

Purpose To understand the impact of breast cancer on older women's survival, we compared survival of older women diagnosed with breast cancer with matched controls. Methods Using the linked 1992 to 2003 Surveillance, Epidemiology, and End Results (SEER) -Medicare data set, we identified women age 67 years or older who were newly diagnosed with ductal carcinoma in situ (DCIS) or breast cancer. We identified women not diagnosed with breast cancer from the 5% random sample of Medicare beneficiaries residing in SEER areas. We matched patient cases to controls by birth year and registry (99% or 66,039 patient cases matched successfully). We assigned the start of follow-up for controls as the patient cases' date of diagnosis. Mortality data were available through 2006. We compared survival of women with breast cancer by stage with survival of controls using multivariable proportional hazards models adjusting for age at diagnosis, comorbidity, prior mammography use, and sociodemographics. We repeated these analyses stratifying by age. Results Median follow-up time was 7.7 years. Differences between patient cases and controls in sociodemographics and comorbidities were small (< 4%). Women diagnosed with DCIS (adjusted hazard ratio [aHR], 0.7; 95% CI, 0.7 to 0.7) or stage I disease (aHR, 0.8; 95% CI, 0.8 to 0.8) had slightly lower mortality than controls. Women diagnosed with stage II disease or higher had greater mortality than controls (stage II disease: aHR, 1.2; 95% CI, 1.2 to 1.2). The association of a breast cancer diagnosis with mortality declined with age among women with advanced disease. Conclusion Compared with matched controls, a diagnosis of DCIS or stage I breast cancer in older women is associated with better survival, whereas a diagnosis of stage II or higher breast cancer is associated with worse survival.

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Intellectual and Functional Outcome of Children 3 Years Old or Younger Who Have CNS Malignancies

Journal of Clinical Oncology ◽

10.1200/jco.2005.01.214 ◽

2005 ◽

Vol 23 (28) ◽

pp. 7152-7160 ◽

Cited By ~ 94

Author(s):

Maryam Fouladi ◽

Elizabeth Gilger ◽

Mehmet Kocak ◽

Dana Wallace ◽

Gray Buchanan ◽

...

Keyword(s):

Functional Outcomes ◽

Intelligence Quotient ◽

Tumor Location ◽

Seizure Disorders ◽

Neurocognitive Evaluation ◽

The Mean ◽

Iq Scores ◽

The Impact ◽

Cns Malignancies

Purpose To evaluate the impact of tumor location, clinical parameters, and therapy on neurocognitive, neuroendocrine, and functional outcomes in children ≤ 3 years old with intracranial CNS malignancies who survived at least 2 years after diagnosis. Patients and Methods Records were retrospectively reviewed for 194 children diagnosed from 1985 to 1999 at St Jude Children's Research Hospital (Memphis, TN). Results The median age at diagnosis was 1.8 years (range, 0.1 to 3.5 years). Median follow-up was 7.64 years (2.0 to 19.4 years). Tumors were infratentorial (102), diencephalic (53), and hemispheric (39); 47% required ventriculoperitoneal shunts, 36% developed seizure disorders, and 20% developed severe ototoxicity. Therapy included no radiation therapy (RT) in 57 (30%), local RT in 87 (45%), and craniospinal irradiation (CSI) in 49 (25%). Overall survival at 10 years was 78 ± 4%. In a longitudinal analysis of 126 patients with at least one neurocognitive evaluation (NE), the mean rate of intelligence quotient (IQ) change for patients who received CSI (−1.34 points per year) and local RT (−0.51 points per year) was significantly different from the no RT group (0.91 points per year; P = .005 and P = .036, respectively). Patients with hemispheric tumors had a significantly greater IQ decline (−1.52 points per year) than those with midline tumors (0.59 points per year; P = .038). Among those with NE ≥ 5 years after diagnosis, 71.4% of CSI recipients compared with 23% of local RT recipients had IQ less than 70 (P = .021). Patients undergoing CSI were more likely to develop endocrinopathies (P < .0001) and to require special education (P = .0007). Conclusion In young children with CNS tumors, CSI and hemispheric location are associated with significant declines in IQ scores.

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Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia

Australian Health Review ◽

10.1071/ah14102 ◽

2015 ◽

Vol 39 (4) ◽

pp. 429 ◽

Cited By ~ 4

Author(s):

Judith M. Katzenellenbogen ◽

Laura J. Miller ◽

Peter Somerford ◽

Suzanne McEvoy ◽

Dawn Bessarab

Keyword(s):

Western Australia ◽

Linked Data ◽

Hospital Admissions ◽

Aboriginal People ◽

Aboriginal Health ◽

Tertiary Hospital ◽

Service Planning ◽

Liaison Officer ◽

The Impact

Objectives The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. Methods A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006–11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. Results There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital re-admissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Conclusions Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes. What is known about the topic? The health gap between Aboriginal and non-Aboriginal Australians is well documented. Aboriginal people have significantly higher hospital utilisation rates, as well as higher rates of complications, comorbidities and discharges against medical advice (DAMA). Aboriginal patients receive most of their specialist services in hospital; however, detailed person-based analyses are limited and planning is often based on crude data. What does this paper add? This is the first analysis of linked data focusing on Aboriginal patient flows and volume and 28-day health system outcomes following hospital admission for all causes in a large metropolitan setting. Because the data were linked, admissions belonging to a single episode of care were combined, ensuring that transfers were not counted as re-admissions. Linkage also allowed follow up across time. The results highlight the main disease groups for which Aboriginal patients are admitted, how this varies by age and the high proportion of patients returning to (any) hospital within 28 days, either through EDs or as booked (pre-arranged) admissions. These data aid in the planning of hospital-based Aboriginal health liaison services. What are the implications for practitioners? The paper outlines the complexity with which many Aboriginal patients present to hospital and the risk of DAMA and re-admission. Clinical and organisational strategies can be put in place in hospitals to address these risks and ensure improved continuity of care with community-based primary health services. The Western Australian South Metropolitan Health Service is reviewing these data and will monitor the impact of the hospital-based AHLO program.

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