The Impact of the COVID-19 Pandemic on Cancer Patient's Management-Lithuanian Cancer Center Experience.

The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (-16%) and endoscopy (-29%) procedures were accompanied by a decreased number of patients with ongoing medical (-30%), radiation (-6%) or surgical (-10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (-14%) and disease follow-up visits (-16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs; the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future.

[Possibilities of diagnosis and treatment of malignant pleural mesothelioma]. / Piktybines pleuros mezoteliomos diagnostikos bei gydymo galimybes.

UNLABELLED: Objective of our work was to evaluate: incidence, ethiology, diagnostic and treatment methods of malignant pleural mesothelioma. MATERIAL AND METHODS: During period 1992-2001 125 cases of pleural mesothelioma were diagnosed in Lithuania. Conventional X-rays and ultrasound were used in 125 cases (100%), chest CT scans in 57 (45.6%), and chest X-rays and CT scans in 38 (30.4%) cases. In 5 cases (4.0%) we performed chest CT scans and MRI. Various surgical diagnostic methods were used: videothoracoscopy in 35 (28.0%) cases, pleural biopsies 72 (57.6%) cases, diagnostic "mini" thoracotomies - 18 (14.4%) cases. Malignant pleural mesothelioma in all cases was proved morphologically. These operations were performed: pleuropulmonectomies - 62 (60.1%), extended pleuropulmonectomies with resections of pericardium and subtotal diaphragm - 10 (9.7%), parietal pleurectomies without resection of lung and pericardium - 17 (16.5%), partial pleurectomies with resection of pericardium - 4 (3.8%), debulking of tumor (partial resections) - 10 (9.7%). Totally 103 patients were operated (82.4%). Twenty two patients were treated conservatively when diagnosis was confirmed. There were such main postoperative complications: fistulas of bronchial stump - 6 cases (5.8%), chylothorax - 5 cases (4.8%), injury of sympatic ganglion - 2 cases (1.9%), and hemothorax - 10 cases (9.7%); 3 patients (2.91%) died after operation. RESULTS: Mean survival time after combined treatment was 12+/-2 months. After conservative treatment alone - 6.0+/-2 months. In combined treatment group 22 patients (17.6%) had recurrence of disease during 3 years. In conservative treatment group no one survived 3 years. CONCLUSIONS: Combined surgical treatment of malignant pleural mesothelioma is still the most effective. Most of diagnosed cases were found in delayed stage. Mean survival time after combined treatment is 12.0+/-2 months, after conservative - 6.0+/-2 months, and recurrence of the disease during 3 years - 17.6% and 100% respectively.

[Surgery for esophageal cancer: 10 years experience]. / Stemples vezio chirurginio gydymo galimybes (10-ties metu patirtis).

UNLABELLED: Objective of work was to evaluate efficacy of surgery for esophageal cancer with one-step gastric pipe reconstruction, to analyze postoperative complications, causes of deaths and patient's life expectancy. In 1992-2002 in Clinic of Surgery Vilnius University Institute of Oncology 213 patients underwent surgery for esophageal cancer; 177 patients (83.0%) were applied transthoracic approach, 34 patients (15.9%) transhiatal and 2 patients (0.9%) Lewis type operations. TNM of patients were T3N1M0 - 99 (46.4%), T2N1M0 - 17 (7.9%), T2N0M0 - 16 (7.5%), T4N2M0 - 54 (25.3%), T2-3N2M1 - 27 (12.6%). Patient performance status according to WHO scale was 0-2. The following postoperative complications were observed: vagus pneumonia - 52 (24.2%) patients, heart insufficiency- 13 patients (6.1%), aortal bleeding 3 (1.4%) patients, suture leakadge - 33 (15.4%) patients, injury of n. reccurentis 17 (7.9%) patients, pleurites 29 (13.6%). Postoperative mortality after transthoracic approach - 29.3%, transhiatal - 15%, Lewis resections - 0%. Median survival after transthoracic approach - 29 months, transhiatal - 34 months, Lewis resections - 39 months. CONCLUSIONS: Surgery for esophageal cancer is the most sufficient way of esophageal cancer treatment. Three-level lymphadenectomies postpone early relapses. Postoperative mortality varies from 15 to 29.3%, median survival from 29 to 39 months.