Understanding the perceived psychological distress and health outcomes of children during COVID-19 pandemic

Objective: The study explored the impacts of restrictions on the perceived psychological distress and health outcomes in children by their mothers who acted as their full-time caregivers during the pan-India lockdown after the outbreak of COVID-19. Method: A narrative qualitative research design was used and a purposive heterogeneous sample of 20 mothers of children aged 9–11 years were chosen, who were in a full-time caregiving role. Data obtained through a telephonic semi-structured interview were analysed using Narrative Thematic Method. Results: Four themes were generated: aberrant social responsivity and loneliness, decreased interest in regular activities, psychological distress and defiant emotional responses, and negative health outcomes. Anxiety, irritation, quarrelsome behaviours, anger, frustration, feeling low, reduced interest in games, boredom, etc. were reported in children. Decreased appetite, sleep disturbances, complaints of indigestion and multiple complaints of body aches were major negative health outcomes. Conclusions: Mothers described a variety of psychological distress and health outcomes for children due to the extreme restrictions, uncertainty, apprehension, reduced positive engagement and lowered social connection after the outbreak of the pandemic. Family-, media-, school- and community-based real or virtual intervention programmes are recommended to minimize the negative impacts and to guard children against the ill-consequences of restrictions of current and future pandemics. © 2021 Australian Psychological Society.

A Prospective Survey to Understand the Preferences and Perspectives of Patients with Hematological Malignancies in a Tertiary Cancer Care Setting in India (CANCOV SURVEY)

Introduction: From its emergence in China on 31 st December 2019, the COVID-19 infection has spread to affect more than 185 million people across the world with approximately 4 million deaths. A systematic review and meta-analysis which included various studies across the world showed that the risk of mortality in cancer patients with COVID-19 infection is 21.1% and the risk of severe disease and mortality due to COVID-19 appears to be higher in patients with hematological malignancies likely due to immunosuppression induced by both the underlying disease and intensive treatment. The experts suggest individualization of treatment based on the prevalence of COVID-19 infection, available infrastructure and social support. Guidelines are driven by opinion from a clinician's perspective. There is a need to evaluate a patient's preference in the present situation when they are faced with the dual problem of cancer and a potentially life-threatening infection. Purpose of study: To document the patients preferences and perspectives using a structured questionnaire when they are on cancer-directed chemo/immune or targeted therapy or treatment naive in our hospital during the current COVID-19 pandemic. Objectives: The primary objective was to determine the proportion of patients who opt to continue on full intensity therapy. The secondary objectives were - to study the factors that lead to treatment discontinuation or dose reduction, to study the level of perceived risk at which patients opt for treatment discontinuation or dose reduction, to study the preferences for treatment continuation in different scenarios (COVID-19 adverse event and different relapse risk) (table 2 and 3) and to understand the difference in preferences for therapy between patients and oncologists/hematologists. Material and methods: This prospective survey was conducted between July 10, 2020 and October 16, 2020. A preconceived standard questionnaire was administered to each patient along with their caregivers (Figure 1). Along with this, we subjected the survey questionnaire separately to the set of medical oncologists/hematologists who were not a part of the patient's treating team and the responses were recorded and studied. Sample Size Assuming that 50% of the patients will continue the full intensity therapy, a sample of 203 will produce a two-sided 90% confidence interval with a precision of 12%. Considering a non-response proportion of 5%, a sample size of 213 was required to achieve primary objective. Results: A total of 200 patients were enrolled in this study with male to female ratio of 1.9:1 and a median age of 42 years (15- 78). Most common hematological malignancy in our study is acute leukemia (29%) followed by CML (23%), NHL (22%), multiple myeloma (16%). Baseline details are represented in Table 1. In this study, 47% patients were willing to receive full intensity chemotherapy (95% CI: 40.4 -54.7). Nature of disease (slow growing vs fast growing) and the intent of treatment (cure vs control of disease) were shown to significantly affect preferences of patients. There was no impact of various socio-economic or logistic factors in their preference for therapy. As high as 50% of the patients were willing to accept only 5% risk of covid 19 related complications to receive full intensity therapy. The acceptable risk of relapse over and above the baseline to receive lesser intensity chemotherapy was 5% for almost 1/3 rd of the patients. If covid related complications are mild, 40% of patients are ready to accept only 1 % risk of relapse to receive lesser intensity chemotherapy. As the risk of covid related complications increases from mild to severe, almost 50% of the patients are ready to accept ≥ 20% risk of relapse to receive lesser intensity chemotherapy (table 4). There was a statistically significant disagreement between physician and patient responses at 5%, 20%, 30% and 40% risk of covid related complications to receive full intensity therapy. When we consider the risk of relapse if lesser intensity therapy is opted, patient and physician responses are in good agreement at 1, 5, 10 and 20% risk levels. Conclusion: Almost 50% of patients are willing to opt for reduced intensity therapy because of fear of covid related complications and there is significant disagreement between patient and physician perspectives in certain clinical contexts. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

The Impact of COVID-19 on Cancer Care in the Post Pandemic World: Five Major Lessons Learnt from Challenges and Countermeasures of Major Asian Cancer Centres.

OBJECTIVE: The COVID-19 pandemic has dramatically affected healthcare services around Asia. The Asian National Cancer Centres Alliance and the Asia-Pacific Organisation for Cancer Prevention collaborated to assess the mid- and long- term impact of COVID-19 to cancer care in Asia. METHODS: The two entities organised a combined symposium and post-meeting interactions among representatives of major cancer centres from seventeen Asian countries to outlining major challenges and countermeasures. RESULTS: Participating stakeholders distilled five big questions. 1) "Will there be an explosion of late-stage cancers after the pandemic?" To address and recover from perceived delayed prevention, screening, treatment and care challenges, collaboration of key stakeholders in the region and alignment in cancer care management, policy intervention and cancer registry initiatives would be of essential value. 2) "Operations and Finance" The pandemic has resulted in significant material and financial casualties. Flagged acute challenges (shortages of supplies, imposition of lockdown) as well as longer-standing reduction of financial revenue, manpower, international collaboration, and training should also be addressed. 3) "Will telemedicine and technological innovations revolutionize cancer care?" Deploying and implementing telemedicine such as teleconsultation and virtual tumour boards were considered invaluable. These innovations could become a new regular practice, leading to expansion of tele-collaboration through collaboration of institutions in the region. 4) "Will virtual conferences continue after the pandemic?" Virtual conferences during the pandemic have opened new doors for knowledge sharing, especially for representatives of low- and middle-income countries in the region, while saving time and costs of travel. 5) "How do we prepare for the next pandemic or international emergency?" Roadmaps for action to improve access to appropriate patient care and research were identified and scrutinised. CONCLUSION: Through addressing these five big questions, focused collaboration among members and with international organisations such as City Cancer Challenge will allow enhanced preparedness for future international emergencies.
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Brachytherapy practice during the COVID-19 pandemic: a review on the practice changes.

The COVID-19 pandemic has caused a havoc across the globe, and has significantly affected oncology services, especially radiation therapy due to the need of social distancing as a measure for the pandemic mitigation. Brachytherapy, being an integral part of radiation therapy, posts a dilemma related to the practice of evidence-based oncology. It requires a significant amount of resources and personnel, thereby increasing the risk of exposure to the virus. There has been a significant amount of papers published providing the best available alternatives to external radiation; however, there is a lack of literature on the practice of brachytherapy. In times of the pandemic, deploying brachytherapy as a treatment modality can act as a double-edged sword and therefore, judicious use is warranted in such times of crisis. In this article, we provide a comprehensive review of the role of brachytherapy in various forms and different malignancy sites.