Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery.

BACKGROUND: This study aimed to estimate potential undetected cancers over the first 2 years of the COVID-19 pandemic in Catalonia. METHODS: Cancer incidence was compared between pre-pandemic (2019) and pandemic (March 2020-January 2022) periods in the Catalan Pathology Registry (CPR) according to sex, age, and tumor site. The correlation between cancer diagnosis and COVID-19 health care workload was also evaluated by means of the Pearson's correlation coefficient (R). The expected incident cancers (E) during the pandemic were estimated by applying 2019 CPR cancer incidence specific rates by sex and 5-year age groups to the 2020 and 2021 Catalan population pyramids. CPR incident cancers were considered observed (O). Standardized incidence ratios (SIR) and 95% confidence intervals (CIs) were calculated using the O/E ratio. RESULTS: After two pandemic years, cancer diagnosis decreased by 12% (SIR 0.88, 95% CI 0.87-0.89), or ∼7700 undetected cancers (13 000 with nonmelanoma skin cancer). Without nonmelanoma skin cancer, 72% of the cancer underdiagnosis was generated in 2020. Diagnoses decreased more in men (whole pandemic -14%; 2020 -21%; 2021 -8%) than in women (-9%, -19%, -3%, respectively), dropping significantly overall in all pandemic waves but the fifth (first -37%, second -16%, third -8%, fourth -6%, fifth -2%, sixth -6%), and across all adult age groups. In the first wave, CPR cancer diagnosis was inversely correlated with COVID-19 caseload in primary care (R -0.91, 95% CI -0.97 to -0.75) and occupancy in conventional hospital wards (R -0.91, 95% CI -0.99 to -0.48) and intensive care (R -0.91, 95% CI 95% -0.98 to -0.70). CONCLUSIONS: Our study evaluated the overall pandemic impact on cancer diagnosis on a large scale and with minimal selection bias, showing that as of February 2022, cancer detection in Catalonia had not yet recovered to pre-pandemic levels. Pending cancer incidence data from population-based cancer registries, early CPR data could inform the development of Spanish cancer control plans.

Elegibilidad de pacientes con esquizofrenia ingresados en una unidad de hospitalización psiquiátrica para participar en ensayos clínicos / Eligibility of schizophrenia inpatients to participate in clinical trials

Introducción: Este estudio pretende evaluar la potencial elegibilidad para la participación en los principales ensayos clínicos de tratamiento de esquizofrenia basados en la práctica clínica (CATIE, CUtLASS y EUFEST) de los pacientes ingresados en una unidad de hospitalización de psiquiatría.Material y métodos: Evaluación retrospectiva, mediante consulta de la historia clínica, de los 241 sujetos (59,8% varones y 40,2% mujeres, edad 39,7±13,0 años), ingresados de forma consecutiva a lo largo de un año en una unidad de hospitalización de psiquiatría con diagnóstico de esquizofrenia u otra psicosis. La influencia de los factores implicados en la no elegibilidad en cada uno de los ensayos clínicos se analizó mediante análisis de regresión logística.Resultados: Un 20,7, un 22,3, y un 22,5% de los pacientes con esquizofrenia u otra psicosis serían elegibles para participar en los estudios CATIE, CUtLASS y EUFEST, respectivamente. Los principales factores implicados en la no elegibilidad fueron la politerapia con antipsicóticos (2 o más) (Odds Ratio (OR): 7,64, intervalo de confianza (IC) 95%: 3,06-19,06, p<0,001), el retraso mental (OR: 16,67, IC 95%: 1,75-166,67, p=0,014) y la resistencia, intolerancia o contraindicación a alguno de los antipsicóticos del estudio (OR: 3,68, IC 95%: 1,13-11,99, p=0,030).Conclusiones: Tres de cada cuatro pacientes con esquizofrenia u otra psicosis ingresados en una unidad de hospitalización de psiquiatría no están representados en los grandes ensayos clínicos de tratamiento de esquizofrenia(AU)

Introduction: This study assesses the potential eligibility of patients admitted to a psychiatric hospitalisation unit to take part in the major clinical trials based on schizophrenia treatment in clinical practice (CATIE, CUtLASS and EUFEST).Material and methods: A retrospective evaluation by consulting the medical records of 241 subjects (59.8% males and 40.2% females, mean age 39.7±13.0 years), admitted consecutively over one year to psychiatric hospitalisation unit with a diagnosis of schizophrenia or another psychosis. The influence of the factors involved in the non-eligibility in each of the clinical trials is analysed using logistic regression analysis.Results: Only 20.7%, 22.3%, and 22.5% of patients with schizophrenia or another psychosis would be eligible to participate in the CATIE, CUtLASS and EUFEST studies, respectively. The main factors involved in the non-eligibility were polytherapy with anti-psychotics (2 or more) (Odds Ratio (OR): 7.64, 95% confidence interval (CI): 3.06-19.06, P<.001), mental retardation (OR: 16.67, 95% CI: 1.75-166.67, P=.014), and resistance, intolerance or contraindication to any of the anti-psychotics of the study (OR: 3.68, 95% CI: 1.13-11.99, P=.030).Conclusions: Three out of every four patients with schizophrenia or another psychosis admitted to a psychiatric hospitalisation unit are not represented in the major clinical trials on schizophrenia treatment(AU)