Impact of the COVID-19 pandemic on cancer care in Ireland - Perspectives from a COVID-19 and Cancer Working Group.

Upon the COVID-19 pandemic onset in Ireland, cancer service disruptions occurred due to prioritisation of COVID-19 related care, redeployment of staff, initial pausing of screening, diagnostic, medical and surgical oncology procedures, staff shortages due to COVID-19 infection and impacts on the physical and mental health of cancer healthcare workers. This was coupled with reluctance among people with symptoms suspicious for cancer to attend for clinical evaluation, due to concerns of contracting the virus. This was further compounded by a cyber-attack on national health service IT systems on May 14th 2021. The Irish Cancer Society, a national cancer charity with a role in advocacy, research and patient supports, convened a multi-disciplinary stakeholder group (COVID-19 and Cancer Working Group) to reflect on and understand the impact of the pandemic on cancer patients and services in Ireland, and discuss potential mitigation strategies. Perspectives on experiences were gathered across domains including timeliness of data acquisition and its conversion into intelligence, and the resourcing of cancer care to address cancer service impacts. The group highlighted aspects for future research to understand the long-term pandemic impact on cancer outcomes, while also highlighting potential strategies to support cancer services, build resilience and address delayed diagnosis. Additional measures include the need for cancer workforce recruitment and retention, increased mental health supports for both patients and oncology professionals, improvements to public health messaging, a near real-time multimodal national cancer database, and robust digital and physical infrastructure to mitigate impacts of the current pandemic and future challenges to cancer care systems.

Palliative Symptom Management in Malignant Pheochromocytoma: Safe Use of Fentanyl and a Review of Medications Used.

Background: Pheochromocytoma is a tumor arising from adrenomedullary chromaffin cells. Five-year survival with malignant pheochromocytoma is <50%. Difficulty arises when prescribing for patients, given the potential to precipitate catecholamine crisis, a life-threatening emergency. Clinical Case: A 60-year-old woman presented with abdominal fullness and discomfort. Liver biopsy confirmed pheochromocytoma. Upper and lower abdominal pain was noted and described as "dragging" and "sharp" in nature. The Endocrine Society Clinical Practice guideline for management of pheochromocytoma recommends avoidance of morphine and codeine. Subcutaneous fentanyl was tolerated with good effect, and a continuous subcutaneous infusion was commenced. She was transitioned to a fentanyl patch and her pain was controlled. Conclusion: Symptom control in patients with pheochromocytoma remains challenging. Common opioid analgesics, dopamine-receptor antagonists, corticosteroids, and tricyclic antidepressants are medications known to precipitate a crisis. There is a lack of published research to support the safe prescribing of medications for these patients.