[EFFECT OF COVID-19 ON ONCOLOGY PATIENTS IN ISRAEL: FROM THE EXPERIENCE OF A TERTIARY CENTER].

INTRODUCTION: The Covid-19 pandemic affects cancer patients in a variety of ways, ranging from delay in diagnosis and treatment to directly causing serious illness. To date, data on the characteristics of Covid-19 disease among cancer patients in Israel have not been published. The aim of this study was to characterize Covid-19 disease patterns among cancer patients treated at a tertiary center. METHODS: Cancer patients positive for Covid-19 between March and October 2020 (including the 1st and 2nd outbreaks) were identified by crossing the databases of the oncology clinic with those of the test data performed at the hospital and in the community. Clinical and demographic data were collected from the medical records. RESULTS: During the study period, 60 cancer patients, out of ~12,000 were identified as positive for Covid-19. Three additional asymptomatic patients were identified by a mandatory screening program established for patients being hospitalized at the oncology department. Of all patients who were diagnosed as positive for Covid-19, 29 (48%) were defined as having a severe disease and 10 (34%) of them died during the data collection period. Those with severe illness were significantly older (71 vs 59 years old p-0.001) and more of them had metastatic disease (47% vs. 53% p-0.01). No significant associations were found between the type of cancer, type of oncology treatment and the severity of Covid-19. Among patients who received active treatment, a delay in treatment was observed for a median time of 17 days. DISCUSSION: Our data indicate relatively low incidence of Covid-19 infection among actively treated cancer patients, possibly due to strict adherence of these patients to social distancing rules. As no association was noted between Covid-19 severity and the oncology treatment, it is probably appropriate to continue optimal cancer care and avoid treatment interruptions even in times of Covid-19 outbreaks.

Implementation of Comprehensive Genomic Profiling in Ovarian Cancer Patients: A Retrospective Analysis.

Comprehensive genomic profiling (CGP) allows for the detection of driver alterations at high resolution, but the limited number of approved targeted therapies and their high costs have contributed to its limited clinical utilization. We retrospectively compared data of 946 women with ovarian cancer (11.4% were referred to CGP, and 88.6% served as control) to examine whether CGP provides a prognosis benefit. Patient baseline parameters were similar between the groups. Cox regression analysis adjusted for age, disease stage at diagnosis, and recurrence status showed statistically significantly longer median overall survival (mOS) in the CGP group versus the control (73.4 versus 54.5 months, p < 0.001). Fifty-four patients (52.9%) had actionable mutations with potential treatments; twenty-six (48.2%) were treated with matched targeted therapy, showing a trend for longer mOS than the eighty-six women in the CGP group who were not given a suggested treatment (105.5 versus 63.6 months, p = 0.066). None of the genomic alterations predicted metastasis location. CCNE1 amplification and KRAS mutations were associated with shorter mOS. Patients with tumor mutation burden ≥4 mutations/megabase had longer mOS. High loss of heterozygosity was associated with longer mOS (99.0 versus 48.2 months, p = 0.004). CGP testing may provide both prognostic and predictive insights for treatment of patients with ovarian cancer. Prospective studies of larger cohorts are warranted.

Diagnostic workup of early-stage breast cancer: can we choose more wisely?

INTRODUCTION: Current international guidelines, including the Choosing Wisely Initiative, recommends against the routine use of systemic imaging studies or tumor markers in early-stage breast cancer. Accumulating data suggests that adherence to these guidelines is low. We aimed to investigate the execution of unnecessary diagnostic tests among Israeli breast cancer patients and identify factors associated with their performance. METHODS: A retrospective analysis was conducted involving a database of early breast cancer patients treated at Tel Aviv Sourasky Medical Center. A survey was distributed among Israeli surgeons and oncologists specializing in breast cancer treatment. RESULTS: The study included early breast cancer patients (n = 178), who have no indication for completing systemic evaluation. Nearly half of the patients (76, 42%) were referred to 128 unjustified diagnostic studies, with the most common referral comprising a PET-CT (n = 39 30.5%). As expected, none of the tests led to any change in either disease staging or alteration in clinical management. Variables associated with systemic evaluation included younger age (61.8% for < 50 years vs 38.9% for > 50 years, p = 0.02), diagnosis by palpable mass compared to screening mammography (26.9% vs 52.9% p = 0.043, respectively) and higher tumor grade (33.7% vs 52.2% p = 0.02, respectively). In concordance with the findings of the database, the physicians' survey revealed low adherence to guidelines and a role of the treating physicians' subjective feelings. Doctors were more likely to recommend unnecessary studies when presented with a clinical case as an image, than to an informative question. CONCLUSIONS: Our data indicate a high rate of non-adherence to guidelines, physicians recommending extensive systemic evaluation for women with early breast cancer. These deviations from the guidelines are associated with subjective factors, some of them being physician-dependent. Initiatives aimed at improving adherence to guidelines, and specifically to guidelines recommending "doing less" should therefore include not just knowledge-based education but also encourage conversation about what is appropriate and necessary.