RESUMEN
BACKGROUND: Primary small cell of esophageal carcinoma is an aggressive tumor with no established treatment guidelines. A treatment strategy was adopted based on small cell carcinoma of the lung because of many similar clinicopathological features. Here, we report one of the largest case series in a western population. AIM: To review the practice of treating small cell oesophageal cancer (SCOC) with different treatment modalities treated at our institution between 2001 and 2014. METHODS: A total of 28 cases of SCOC have been identified. All cases were identified with a ten-digit code known as the CHI number. Data was collected using a combination of an electronic database, case notes and the chemotherapy electronic prescribing system (chemocare). We collected information on age, gender, performance status, staging of the disease (limited stage vs extensive stage). RESULTS: The results showed 17 patients (61%) were diagnosed with limited stage small cell oesophageal cancer (LS-SCOC), while 11 patients (39%) were diagnosed with extensive stage small cell oesophageal cancer (ES-SCOC). The median age at diagnosis of SCOC was 72 years (range 52-86). The median survival for patients with ES-SCOC was 7 mo (95%CI: 1-12) vs LS-SCOC [median 23 mo (95%CI: 14-40)], P < 0.0001. Subgroup analysis of those who received treatment showed the median survival for patients who received palliative chemotherapy was 7 mo (95%CI: 1.5-12), concurrent chemoradiation 45 mo (95%CI: 38-) and sequential chemoradiation 20 mo (95%CI: 17-25), P < 0.0001. CONCLUSION: Our data strongly support the use of concurrent chemoradiation in the treatment of LS-SCOC in patients who are fit with no significant comorbidity.
RESUMEN
BACKGROUND: During the coronavirus disease (COVID-19) pandemic, patients with cancer in rural settings and distant geographical areas will be affected the most by curfews. Virtual management (telemedicine) has been shown to reduce health costs and improve access to care. OBJECTIVE: The aim of this survey is to understand oncologists' awareness of and views on virtual management, challenges, and preferences, as well as their priorities regarding the prescribing of anticancer treatments during the COVID-19 pandemic. METHODS: We created a self-administrated electronic survey about the virtual management of patients with cancer during the COVID-19 pandemic. We evaluated its clinical sensibility and pilot tested the instrument. We surveyed practicing oncologists in Gulf and Arab countries using snowball sampling via emails and social media networks. Reminders were sent 1 and 2 weeks later using SurveyMonkey. RESULTS: We received 222 responses from validated oncologists from April 2-22, 2020. An awareness of virtual clinics, virtual multidisciplinary teams, and virtual prescriptions was reported by 182 (82%), 175 (79%), and 166 (75%) respondents, respectively. Reported challenges associated with virtual management were the lack of physical exam (n=134, 60%), patients' awareness and access (n=131, 59%), the lack of physical attendance of patients (n=93, 42%), information technology (IT) support (n=82, 37%), and the safety of virtual management (n=78, 35%). Overall, 111 (50%) and 107 (48%) oncologists did not prefer the virtual prescription of chemotherapy and novel immunotherapy, respectively. However, 188 (85%), 165 (74%), and 127 (57%) oncologists preferred the virtual prescription of hormonal therapy, bone modifying agents, and targeted therapy, respectively. In total, 184 (83%), 183 (83%), and 176 (80%) oncologists preferred to continue neoadjuvant, adjuvant, and perioperative treatments, respectively. Overall, 118 (53%) respondents preferred to continue first-line palliative treatment, in contrast to 68 (30%) and 47 (21%) respondents indicating a preference to interrupt second- and third-line palliative treatment, respectively. For administration of virtual prescriptions, all respondents preferred the oral route and 118 (53%) preferred the subcutaneous route. In contrast, 193 (87%) did not prefer the intravenous route for virtual prescriptions. Overall, 102 (46%) oncologists responded that they would "definitely" prefer to manage patients with cancer virtually. CONCLUSIONS: Oncologists have a high level of awareness of virtual management. Although their survey responses indicated that second- and third-line palliative treatments should be interrupted, they stated that neoadjuvant, adjuvant, perioperative, and first-line palliative treatments should continue. Our results confirm that oncologists' views on the priority of anticancer treatments are consistent with the evolving literature during the COVID-19 pandemic. Challenges to virtual management should be addressed to improve the care of patients with cancer.
