Impact of the Early Phase of the COVID-19 Pandemic on the Quality of Care for Colorectal and Anal Cancers at Comprehensive Cancer Centers on Two Continents.

PURPOSE: The early phase of the COVID-19 pandemic affected cancer care globally. Evaluating the impact of the pandemic on the quality of cancer care delivery is crucial for understanding how changes in care delivery may influence outcomes. Our study compared care delivered during the early phase of the pandemic with the same period in the previous year at two institutions across continents (Princess Margaret Cancer Center [PM] in Canada and A.C. Camargo Cancer Center [AC] in Brazil). METHODS: Patients newly diagnosed with colorectal or anal cancer between February and December 2019 and the same period in 2020 were analyzed. Sociodemographic and clinical characteristics and performance of individual indicators within and between centers and between the peri-COVID-19 and control cohorts were tested using Cohen's h test to assess the standardized differences between the two groups. RESULTS: Among 925 patients, distinct effects of the early COVID-19 pandemic on oncology services were observed. AC experienced a 50% reduction in patient consultations (98 v 197) versus a 12.5% reduction at PM (294 v 336). Similarly, AC experienced a higher proportion of stage IV disease presentations (42.9% v 29.9%; P = .015) and an increase in treatment delay (61.9% v 9.7%; P < .001) compared with prepandemic. At PM, a 10% increase in treatment interruption (32.4% v 22.3%; P < .001) and a higher rate of discontinuation of radiotherapy (9.4% v 1.1%; P < .001) were observed during the pandemic. Postsurgical readmission rates increased in both AC (20.9% v 2.6%; P < .001) and PM (10.5% v 3.6%; P < .01). CONCLUSION: The early phase of the COVID-19 pandemic affected the quality of care delivery for colorectal and anal cancers at both centers. However, the magnitude of this impact was greater in Brazil.

Drug interactions and oncological outcomes: a hidden adversary.

Patients with cancer are at particularly high risk of drug-drug interactions, with approximately 30% of them being exposed to potentially dangerous drug-drug combinations. Yet the real impact of such interactions on oncology practice remains mostly unknown, partly because of the challenges associated with disentangling the effects of harmful interactions from expected side effects of therapy or disease-related symptoms. Recently, some studies have looked at how oncologic outcomes are influenced by drug-drug interactions. In this editorial, we discuss the drug combinations that should be avoided, such as, for example, capecitabine and proton-pump inhibitors, and how research should be conducted in this neglected but clinically relevant topic.

Self-reported conflicts of interest of authors, trial sponsorship, and the interpretation of editorials and related phase III trials in oncology.

PURPOSE: Growing participation by industry in cancer research has resulted in increased reporting of conflicts of interest (COI). We aimed to test any association between authors' conclusions and self-reported COI or trial sponsorship in cancer studies. METHODS: Editorials and related phase III trials published in six clinical oncology journals in the last 3.5 years were analyzed independently by two investigators who classified study conclusions according to authors' endorsement of the experimental therapy. Logistic regression multivariable models were used to assess predictors of favorable conclusions of editorialists and of phase III authors. RESULTS: From January 2008 to October 2011, 1,485 articles were retrieved: 150 phase III trials and 150 editorials were eligible. Among the phase III trials, 82 (54.7%) had positive results, and 78 (52.0%) were entirely or partially funded by industry. Any COI were disclosed in 103 phase III trials (68.7%) and in 71 editorials (47.3%). Multivariable analysis showed that phase III trial results were the only significant predictor for a positive conclusion by trial authors (odds ratio [OR], 92.2; 95% CI, 19.7 to 431.6; P < .001). Sponsorship did not predict for positive conclusion by phase III authors (OR, 0.86; 95% CI, 0.3 to 2.5; P = .788). The only factor associated with positive conclusions by editorial authors was a positive conclusion by phase III trial authors (OR, 36.3; 95% CI, 6.8 to 194.2; P < .001). CONCLUSION: The interpretation of recently published phase III cancer trials by their authors or by editorialists was not influenced by financial relationships or industry sponsorship. Increased awareness of COI policies may have led to more integrity in cancer research reporting.

Futile medication use in terminally ill cancer patients.

BACKGROUND: Cancer patients usually take many medications. The proportion of patients with advanced cancer who are taking futile drugs is unknown. MATERIALS AND METHODS: We retrospectively reviewed the charts of all consecutive ambulatory patients with advanced cancer and who were receiving supportive care exclusively at palliative care clinics, Princess Margaret Hospital, to gather information on futile medications used by them. Futile medications were defined as unnecessary (when no short-term benefit to patients with respect to survival, quality of life, or symptom control was anticipated) or duplicate (two or more drugs from the same pharmacological class). Summary statistics were used to describe the results. RESULTS: From November 2005 to July 2006, 82 (22%) of 372 patients were taking at least one futile medication before consultation; after initial consultation, this proportion dropped to 20% (78): 70 patients were taking unnecessary medications, while eight were on duplicate medications. The most frequent unnecessary medications used by patients were statins (56%). The most common duplicate medication involved the use of two different benzodiazepines (seven patients). CONCLUSION: About one fifth of cancer outpatients at the end of life take futile medications, most commonly statins. Prospective and population-based studies are warranted to further evaluate the magnitude and consequences of futile medication use in oncology.

Disclosure of conflicts of interest by authors of clinical trials and editorials in oncology.

PURPOSE: There is concern that financial relationships between sponsors and investigators may bias research results. Our objective was to evaluate the epidemiology of conflicts of interest (COIs) among authors of clinical trials and editorials in oncology and the relationship between COI disclosure and source of funding. METHODS: We did a cross-sectional survey of clinical trials and editorials of anticancer agents and supportive care medications published in the Journal of Clinical Oncology (JCO) during a 1-year period. RESULTS: Of 1,533 articles published in JCO between January 1, 2005, and January 31, 2006, 332 met our inclusion criteria; 289 (87%) were clinical trials, and 43 (13%) were editorials. The pharmaceutical industry entirely or partially funded 44% of the clinical trials. At least one COI was disclosed in 69% of clinical trials and 51% of editorials. The most common types of COI reported by authors were consultancy fees, honoraria, and research funds. The highest monetary levels of interest reported by authors were for research grants, but the majority of authors with COIs received less than US$10,000. In multivariable analysis, authors of clinical trials conducted in North America (North America v Europe: odds ratio [OR] = 2.9, P = .002) and authors of trials funded entirely (industry only v nonprofit: OR = 13.8, P < .001) or partially (both industry and nonprofit v nonprofit only: OR = 5.8, P < .001) by industry were more likely to report personal COIs. CONCLUSION: COIs are common in clinical cancer research and usually take the form of consultancy fees, honoraria, and research funds. Source of study funding was significantly associated with COI disclosure.