COVID-19: Third dose booster vaccine effectiveness against breakthrough coronavirus infection, hospitalisations and death in patients with cancer: A population-based study.

PURPOSE: People living with cancer and haematological malignancies are at an increased risk of hospitalisation and death following infection with acute respiratory syndrome coronavirus 2. Coronavirus third dose vaccine boosters are proposed to boost waning immune responses in immunocompromised individuals and increase coronavirus protection; however, their effectiveness has not yet been systematically evaluated. METHODS: This study is a population-scale real-world evaluation of the United Kingdom's third dose vaccine booster programme for cancer patients from 8th December 2020 to 7th December 2021. The cancer cohort comprises individuals from Public Health England's national cancer dataset, excluding individuals less than 18 years. A test-negative case-control design was used to assess the third dose booster vaccine effectiveness. Multivariable logistic regression models were fitted to compare risk in the cancer cohort relative to the general population. RESULTS: The cancer cohort comprised of 2,258,553 tests from 361,098 individuals. Third dose boosters were evaluated by reference to 87,039,743 polymerase chain reaction coronavirus tests. Vaccine effectiveness against breakthrough infections, symptomatic infections, coronavirus hospitalisation and death in cancer patients were 59.1%, 62.8%, 80.5% and 94.5%, respectively. Lower vaccine effectiveness was associated with a cancer diagnosis within 12 months, lymphoma, recent systemic anti-cancer therapy (SACT) or radiotherapy. Patients with lymphoma had low levels of protection from symptomatic disease. In spite of third dose boosters, following multivariable adjustment, individuals with cancer remain at an increased risk of coronavirus hospitalisation and death compared to the population control (OR 3.38, 3.01, respectively. p < 0.001 for both). CONCLUSIONS: Third dose boosters are effective for most individuals with cancer, increasing protection from coronavirus. However, their effectiveness is heterogenous and lower than the general population. Many patients with cancer will remain at the increased risk of coronavirus infections even after 3 doses. In the case of patients with lymphoma, there is a particularly strong disparity of vaccine effectiveness against breakthrough infection and severe disease. Breakthrough infections will disrupt cancer care and treatment with potentially adverse consequences on survival outcomes. The data support the role of vaccine boosters in preventing severe disease, and further pharmacological intervention to prevent transmission and aid viral clearance to limit the disruption of cancer care as the delivery of care continues to evolve during the coronavirus pandemic.

A population-based survey of lumbar surgery beliefs in the United States.

INTRODUCTION: Studies have shown that lumbar surgery (LS) outcomes may be influenced by perception. However, the perceptions of the general population regarding LS are not known. Therefore, the purpose of this study was to investigate the general population's perceptions regarding LS. SUBJECTS: This study included 262 participants (mean age: 46.1 years; 125 males and 137 females) from the Las Vegas (NV) metropolitan area. METHODS: A questionnaire was developed by an expert panel and was assessed for face and content validity. After revision and establishment of test-retest reliability, participants were surveyed at 12 randomly selected grocery stores in Las Vegas. The questionnaire assessed demographics, personal and family medical history, and 11 items pertaining to perceptions of LS. RESULTS: The participants had a somewhat uncertain expectation about the potential success of LS; however, approximately two-thirds believed that LS is unsuccessful to the point that they would not be able to return to their previous level of activity after LS. Of the questions dealing with success of LS, the neutral response had the greatest frequency suggesting a lack of knowledge or uncertainty about LS. More than half of the respondents were fearful of LS and anticipated a protracted recovery accompanied by undesired side effects. Three quarters of the respondents agreed that they would try all other means of treatment before opting for LS, yet 39% said that they would undergo LS if they had severe lower back pain (LBP). CONCLUSIONS: The general population has an uncertain view of LS outcomes and anticipates postoperative side effects and a protracted recovery; these views may explain why a majority of participants expressed fear of LS and why most would only opt for LS as a last resort. This uncertainty and anticipation of poor outcomes may be a strong contributor to preoperative fear and anxiety, which could deleteriously influence postoperative outcomes.