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1.
Anticancer Res ; 41(11): 5377-5391, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732407

RESUMO

BACKGROUND/AIM: To assess the quantity and quality of systematic reviews of in vitro cancer studies. MATERIALS AND METHODS: PubMed, MEDLINE, Embase, Web of Knowledge and PROSPERO databases were searched. Articles described as systematic reviews of in vitro studies, focused on or relevant to cancer and published in English were selected and appraised using an adapted version of AMSTAR 2 'critical domains'. RESULTS: From 4,021 records, 41 reviews described as systematic and cancer-related were identified. Publication dates indicate increasing frequency of systematic review conduct. Mean number of databases searched was three (range=1-8). Thirty-six reviews (88%) reported search methods, 35 (85%) specified inclusion criteria, 26 (63%) reported study selection methods, and 21 (51%) used reporting guidelines. Only 13 reviews (32%) involved formal quality assessment. CONCLUSION: Detailed investigation of reviews of cancer-relevant in vitro studies indicates need for further development and use of robust search strategies, appropriate quality assessment tools, and researchers with relevant skills.


Assuntos
Pesquisa Biomédica/normas , Confiabilidade dos Dados , Oncologia/normas , Publicações Periódicas como Assunto/normas , Projetos de Pesquisa/normas , Revisões Sistemáticas como Assunto/normas , Animais , Guias como Assunto/normas , Humanos , Controle de Qualidade
2.
Curr Treat Options Oncol ; 22(10): 95, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34515857

RESUMO

OPINION STATEMENT: While emergency use is authorized for numerous COVID-19 vaccines and the high-risk population including cancer patients or those with immunosuppression due to disease or therapy is prioritized, data on this group's specific safety and efficacy of these vaccines remains limited. Safety data from clinical trials and population data may be extrapolated, and these vaccines may be used for cancer patients. However, concerns of efficacy due to the variable immune response in patients with active cancers undergoing active therapy and cancer survivors with chronic immunosuppression remain. The authors aim to discuss the current recommendations for use of COVID-19 vaccination in patients with cancer.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Neoplasias/imunologia , Vacinação/efeitos adversos , COVID-19/complicações , Humanos , Sistema Imunitário , Imunização , Hospedeiro Imunocomprometido , Imunossupressão , Oncologia/normas , Neoplasias/complicações , Segurança do Paciente , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Resultado do Tratamento
3.
Klin Onkol ; 34(3): 211-219, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34362259

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19), a respiratory tract infection caused by the severe acute respiratory syndrome coronavirus named SARS-CoV-2, initially emerged in China in late 2019. The rapid global spread of this novel virus led the World Health Organization declare a pandemic with > 30,000,000 confirmed cases, 946,000 deaths and > 21,000,000 recoveries reported as of 18 September 2020, according to the Johns Hopkins Coronavirus Resource Center. Initial reports from Asia suggested that elderly patients with multiple comorbidities, specifically diabetes, hypertension, and obesity were at an increased risk of developing severe COVID-19 following a SARS-CoV-2 infection. As data on these risks have evolved, evidence has increasingly shown that patients with cancer are indeed a particularly vulnerable group. However, the effects of various confounding factors, including an older than average patient population who often have underlying comorbidities including a suppressed immune system and/ or a hypercoagulable state, have been difficult to separate from the effects of having cancer. Common presenting symptoms of SARS-CoV-2 including dyspnoea, cough, fever, fatigue, dysgeusia and, less commonly, diarrhoea and/ or a hyperinflammatory syndrome are equally confusing to clinicians as they all are common symptoms of both cancer and toxicity from anti-cancer therapy. Furthermore, the radiographic dilemma of distinguishing between immune-checkpoint inhibitor-induced pneumonitis from that caused by SARS-CoV-2 infection and conflicting data on the effects of certain therapies on patient outcomes has left clinicians with considerable angst on how to help patients with acute or worsening symptoms in an optimal way. Predicted increase in mortality follows not only from the delay in discovery and progress resulting from temporary closing of research laboratories at cancer centers but also from diversion of resources to patient care and temporary suspension of clinical trial enrolment both by companies and local institutions. The possibilities of travelling to specialized medical centers whose activities are essential for the delivery and improvement of patient care were reduced, too. Viral mutations might also occur during transmission and spread; this leads to a statement that SARS-CoV-2 will forever remain a looming threat to the oncological community. What is crucial to remember is that cancer itself is a pandemic with > 18,000,000 people dia-gnosed worldwide every year. Many societies, including the European Society for Medical Oncology and the American Society of Clinical Oncology, are providing clinical recommendations for the management of patients with cancer during this challenging time, recognizing that continuation in the precise treatment of our patients is critical for our role of physicians. PURPOSE: The aim of the presentation is to point out the contact or overlapping areas of both mentioned disease entities for the purpose of possible simplification of dia-gnostic and therapeutic management of a cancer patient with suspected or already proven  COVID-19 disease.


Assuntos
COVID-19/complicações , Oncologia/normas , Neoplasias/terapia , Guias de Prática Clínica como Assunto/normas , SARS-CoV-2/isolamento & purificação , COVID-19/virologia , Humanos , Neoplasias/epidemiologia , Neoplasias/virologia
5.
Clin J Oncol Nurs ; 25(4): 361-362, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34269344

RESUMO

Now that the SARS-CoV-2 virus and its variants have altered clinical oncology practice as we know it, let's return to a familiar focus from the Core Curriculum for Oncology Nursing-pain management. Much has happened during the past two years that influences the effective management of pain in patients with cancer-not the least of which is a clinical environment that has been changed by the COVID-19 pandemic.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , COVID-19/epidemiologia , Dor do Câncer/tratamento farmacológico , Oncologia/normas , Enfermagem Oncológica/normas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Manejo da Dor/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Estados Unidos/epidemiologia
6.
Cancer Treat Rev ; 99: 102208, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34238640

RESUMO

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Pancreatic cancer is an increasing cause of cancer mortality and has wide variation in treatment and care in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must be carried out only in pancreatic cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.


Assuntos
Neoplasias Pancreáticas/terapia , Humanos , Oncologia/normas , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde
7.
Pediatr Clin North Am ; 68(4): 811-824, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34247711

RESUMO

This article provides general principles of managing children with central nervous system tumors. The distribution, diagnostic work-up, and key principles of treatment are reviewed, and special circumstances that may be encountered by pediatricians in the community are discussed.


Assuntos
Neoplasias Encefálicas/terapia , Neoplasias do Sistema Nervoso Central/terapia , Oncologia/normas , Atenção Primária à Saúde/normas , Neoplasias da Medula Espinal/terapia , Criança , Humanos , Pediatria/normas
8.
JCO Oncol Pract ; 17(8): 475-492, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34255551

RESUMO

PURPOSE: To provide Standards on the basis of evidence and expert consensus for a pilot of the Oncology Medical Home (OMH) certification program. The OMH model is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement. The OMH pilot is intended to inform further refinement of Standards for OMH model implementation. METHODS: An Expert Panel was formed, and a systematic review of the literature on the topics of OMH, clinical pathways, and survivorship care plans was performed using PubMed and Google Scholar. Using this evidence base and an informal consensus process, the Expert Panel developed a set of OMH Standards. Public comments were solicited and considered in preparation of the final manuscript. RESULTS: Three comparative peer-reviewed studies of OMH met the inclusion criteria. In addition, the results from 16 studies of clinical pathways and one systematic review of survivorship care plans informed the evidence review. Limitations of the evidence base included the small number of studies of OMH and lack of longer-term outcomes data. More data were available to inform the specific Standards for pathways and survivorship care; however, outcomes were mixed for the latter intervention. The Expert Panel concluded that in the future, practices should be encouraged to publish the results of OMH interventions in peer-reviewed journals to improve the evidence base. STANDARDS: Standards are provided for OMH in the areas of patient engagement, availability and access to care, evidence-based medicine, equitable and comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and chemotherapy safety. Additional information, including a Standards implementation manual, is available at www.asco.org/standards.


Assuntos
Atenção à Saúde/normas , Oncologia , Assistência Centrada no Paciente , Humanos , Oncologia/normas , Cuidados Paliativos/normas , Assistência Centrada no Paciente/normas
9.
J Cancer Res Ther ; 17(2): 547-550, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34121706

RESUMO

Purpose: Health emergency due to COVID-19 started in Uruguay on March 13, 2020; our mastology unit tried to ensure adequate oncological care, and protect patients from the virus infection and complications. Objective: To assess the health care activities in the "peak" of the pandemic during 3 months. Materials and Methods: we collected data from the electronic health record. Results: There were a total of 293 medical appointments from 131 patients (221 face-to-face), that decreased by 16.7% compared to the same period in 2019 (352 appointments). The medical appointments were scheduled to evaluate the continuity of systemic treatment or modifications (95 patients; 72.5%), follow-up (17; 12.9%), first-time consultation (12; 9.1%), and assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). New twenty treatments were initiated. Of the 14 patients that were on adjuvant/neoadjuvant CT, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte-colony-stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. Of the seven patients that were on palliative CT, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one and due to progression of the disease in the other patient). The ninety patients who were receiving adjuvant, neoadjuvant, or palliative criteria hormone therapy and/or anti-HER2 therapies, continued the treatment with no changes. Conclusions: The evidence suggests that, although medical appointments decreased by approximately 17%, we could maintain healthcare activities, continued most of the treatments while the most modified was CT with G-CSF to avoid myelosuppression.


Assuntos
Neoplasias da Mama/tratamento farmacológico , COVID-19/epidemiologia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Medula Óssea/efeitos dos fármacos , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/imunologia , COVID-19/imunologia , COVID-19/prevenção & controle , COVID-19/transmissão , Controle de Doenças Transmissíveis/normas , Continuidade da Assistência ao Paciente/organização & administração , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Hematopoese/efeitos dos fármacos , Hematopoese/imunologia , Humanos , Oncologia/organização & administração , Oncologia/normas , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Telemedicina/organização & administração , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Triagem/organização & administração , Triagem/normas , Uruguai/epidemiologia
10.
Ann R Coll Surg Engl ; 103(7): 520-523, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192482

RESUMO

INTRODUCTION: In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. METHODS: We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. RESULTS: Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). CONCLUSIONS: While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.


Assuntos
COVID-19/prevenção & controle , Neoplasias Colorretais/diagnóstico , Oncologia/métodos , Consulta Remota/métodos , Telefone , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Neoplasias Colorretais/terapia , Humanos , Controle de Infecções/normas , Satisfação no Emprego , Oncologia/normas , Oncologia/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Consulta Remota/normas , Consulta Remota/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido/epidemiologia
11.
Curr Opin Oncol ; 33(4): 279-286, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100467

RESUMO

PURPOSE OF REVIEW: Cancer treatment options have developed rapidly in the past years. Targeted- and immune therapy have resulted in additional supportive care needs. This review describes a teaching program in supportive care. RECENT FINDINGS: Supportive care begins at the time of cancer diagnosis and continues until the patient has died or is cured and late toxicities and other survivorship issues have been properly addressed. Supportive care is divided into four phases. In the curative phase, competences regarding prevention and management of acute treatment and subacute treatment side effects are important. In the survivorship phase, competences related to late toxicity and chronic toxicity are warranted. In the palliative phase, focus will be on competences concerning cancer complications, and specific end-of-life competences are needed as well. Obviously some competences are needed in all phases, for example, communication skills. SUMMARY: Competences concerning symptoms and complications are summarized for each phase in table format. General competences are listed in the text body of the manuscript. Regular update and implementation is crucial. The future cancer population will consist of a higher number of older cancer patients and survivors. This should reflect curriculum updates as should the increasing possibilities for multigene sequencing enabling personal medicine (including supportive care) to a larger extent than today.


Assuntos
Oncologia/educação , Neoplasias/terapia , Cuidados Paliativos/métodos , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Humanos , Oncologia/métodos , Oncologia/normas , Cuidados Paliativos/normas
12.
Cancer Treat Rev ; 99: 102229, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34139476

RESUMO

Treatment of HER2-positive early breast cancer (EBC) continues to evolve with neoadjuvant (pre-operative) and adjuvant (post-operative) HER2-targeted therapies as standard of care. There are two important decision points. The first involves deciding between neoadjuvant therapy or proceeding directly to surgery. Neoadjuvant chemotherapy (NACT) plus pertuzumab-trastuzumab is appropriate for patients with high-risk HER2-positive EBC (tumour diameter ≥2 cm, and/or node-positive disease). Patients with node-negative disease and tumour diameter <2 cm are candidates for upfront surgery followed by paclitaxel for 12 weeks plus 18 cycles of trastuzumab, with the option to add pertuzumab (if pN+). The second decision point involves the pathohistological result at surgery after neoadjuvant therapy. Total pathological complete response (tpCR: ypT0/is, ypN0) is associated with improved survival endpoints. Patients with tumours ≥2 cm and/or node-positive disease at diagnosis who have a tpCR after dual blockade should continue pertuzumab-trastuzumab in the adjuvant setting to complete 1 year (18cycles) of treatment. For patients with invasive residual disease, 14cycles of post-neoadjuvant trastuzumab emtansine (T-DM1) therapy significantly increases invasive-DFS compared with trastuzumab. Extended adjuvant therapy with neratinib is an option in selected patients (HER2-positive and oestrogen receptor [ER]-positive) who have completed adjuvant trastuzumab-based therapy. Less aggressive chemotherapy regimens are recommended in populations with a lower risk of recurrence (patients with small tumours without axillary involvement; patients unlikely to tolerate anthracycline-taxane or taxane-carboplatin regimens). Ultimately, treatment recommendations should be consistent with local and international guidelines. Further studies will guide optimisation of treatment for patients with HER2-positive EBC according to the risk of disease recurrence.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Tomada de Decisões , Receptor ErbB-2/antagonistas & inibidores , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Feminino , Humanos , Metástase Linfática , Oncologia/normas , Terapia Neoadjuvante , Inibidores de Proteínas Quinases/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptor ErbB-2/metabolismo , Fatores de Risco
14.
Eur J Cancer ; 152: 90-99, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34090144

RESUMO

BACKGROUND: Patient-reported outcomes (PROs) are the gold standard to assess the patients' subjective health status. While both the Food and Drug Administration and European Medicines Agency recommend the use of PROs as end-points in paediatric clinical trials to support claims for medical product labelling, it is not known how often PROs are actually used. The aim of this study was to assess the usage of PRO instruments in childhood cancer clinical trials investigating anti-cancer medication. METHODS: In June 2020 ClinicalTrials and EudraCT were systematically searched for all trials including children and adolescents (≤21 years) with cancer registered between 2007 and 2020. The use of PRO measures and trials characteristics were analysed. To investigate which trial characteristics are associated with the use of PROs, a binary logistic regression was calculated. RESULTS: Of 4789 identified trials, 711 were included. The most frequent reason for exclusion was age limitation (age >21 years). Of all included trials, only 8.2% used PROs as end-points; .6% as the primary end-point. The most commonly used questionnaire was the PedsQL™ (32.8%), followed by the Patient-Reported Outcomes Measurement Information System scales (12.1%). No association was observed between the use of PROs and trial region, number of centres, trial phase, time period or intervention type (all p > .05). The use of PROs did not substantially increase over time. Only 20.3% of the closed studies had published their results. CONCLUSION: Despite recommendations of regulatory agencies, PRO assessment is extremely rare in paediatric oncology clinical trials. More efforts should be undertaken to facilitate implementation of PRO in paediatric trials to guarantee patient-centred research and treatments.


Assuntos
Antineoplásicos/administração & dosagem , Ensaios Clínicos como Assunto/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros/estatística & dados numéricos , Antineoplásicos/efeitos adversos , Criança , Ensaios Clínicos como Assunto/normas , Humanos , Oncologia/normas , Oncologia/estatística & dados numéricos , Neoplasias/diagnóstico , Neoplasias/psicologia , Assistência Centrada no Paciente/normas , Qualidade de Vida , Projetos de Pesquisa/normas , Projetos de Pesquisa/estatística & dados numéricos
15.
Lancet Oncol ; 22(7): e327-e340, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34000244

RESUMO

Breast cancer is increasingly prevalent in older adults and is a substantial part of routine oncology practice. However, management of breast cancer in this population is challenging because the disease is highly heterogeneous and there is insufficient evidence specific to older adults. Decision making should not be driven by age alone but should involve geriatric assessments plus careful consideration of life expectancy, competing risks of mortality, and patient preferences. A multidisciplinary taskforce, including members of the European Society of Breast Cancer Specialists and International Society of Geriatric Oncology, gathered to expand and update the previous 2012 evidence-based recommendations for the management of breast cancer in older individuals with the endorsement of the European Cancer Organisation. These guidelines were expanded to include chemotherapy toxicity prediction calculators, cultural and social considerations, surveillance imaging, genetic screening, gene expression profiles, neoadjuvant systemic treatment options, bone-modifying drugs, targeted therapies, and supportive care. Recommendations on geriatric assessment, ductal carcinoma in situ, screening, primary endocrine therapy, surgery, radiotherapy, adjuvant systemic therapy, and secondary breast cancer were updated.


Assuntos
Neoplasias da Mama/terapia , Oncologia/normas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Tomada de Decisão Clínica , Consenso , Técnicas de Apoio para a Decisão , Feminino , Avaliação Geriátrica , Humanos , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
16.
Oncol Res Treat ; 44(6): 354-359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33940575

RESUMO

Treatment of cancer patients has become challenging when large parts of hospital services need to be shut down as a consequence of a local COVID-19 outbreak that requires rapid containment measures, in conjunction with the shifting of priorities to vital services. Reports providing conceptual frameworks and first experiences on how to maintain a clinical hematology/oncology service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are scarce. Here, we report our first 8 weeks of experience after implementing a procedural plan at a hematology/oncology unit with its associated cancer center at a large academic teaching hospital in Germany. By strictly separating team workflows and implementing vigorous testing for SARS-CoV-2 infections for all patients and staff members irrespective of clinical symptoms, we were successful in maintaining a comprehensive hematology/oncology service to allow for the continuation of treatment for our patients. Notably, this was achieved without introducing or further transmitting SARS-CoV-2 infections within the unit and the entire center. Although challenging, our approach appears safe and feasible and may help others to set up or optimize their procedures for cancer treatment or for other exceedingly vulnerable patient cohorts.


Assuntos
COVID-19/prevenção & controle , Hematologia/normas , Oncologia/normas , Pandemias/prevenção & controle , Centros de Atenção Terciária/normas , Adulto , Alemanha , Humanos , Neoplasias/terapia , SARS-CoV-2/patogenicidade
17.
J Oncol Pharm Pract ; 27(4): 785-801, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34024179

RESUMO

The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.


Assuntos
Oncologia/normas , Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração , Sociedades Farmacêuticas , Antineoplásicos/uso terapêutico , Educação em Farmácia , Fidelidade a Diretrizes , Humanos , Assistência ao Paciente , Segurança do Paciente , Assistência Farmacêutica , Farmacêuticos , Técnicos em Farmácia , Pesquisa , Especialização
18.
Gynecol Oncol ; 162(1): 12-17, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33941382

RESUMO

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Neoplasias dos Genitais Femininos/cirurgia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Canadá/epidemiologia , Institutos de Câncer/organização & administração , Institutos de Câncer/normas , Institutos de Câncer/estatística & dados numéricos , Controle de Doenças Transmissíveis/normas , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Ginecologia/economia , Ginecologia/organização & administração , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Hospitais Privados/economia , Hospitais Privados/organização & administração , Hospitais Privados/normas , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Oncologia/economia , Oncologia/organização & administração , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo , Triagem/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
19.
Gynecol Oncol ; 162(1): 4-11, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33994014

RESUMO

OBJECTIVE: The COVID-19 pandemic has quickly transformed healthcare systems with expansion of telemedicine. The past year has highlighted risks to immunosuppressed cancer patients and shown the need for health equity among vulnerable groups. In this study, we describe the utilization of virtual visits by patients with gynecologic malignancies and assess their social vulnerability. METHODS: Virtual visit data of 270 gynecology oncology patients at a single institution from March 1, 2020 to August 31, 2020 was obtained by querying a cohort discovery tool. Through geocoding, the CDC Social Vulnerability Index (SVI) was utilized to assign social vulnerability indices to each patient and the results were analyzed for trends and statistical significance. RESULTS: African American patients were the most vulnerable with a median SVI of 0.71, Asian 0.60, Hispanic 0.41, and Caucasian 0.21. Eighty-seven percent of patients in this study were Caucasian, 8.9% African American, 3.3% Hispanic, and 1.1% Asian, which is comparable to the baseline institutional gynecologic cancer population. The mean census tract SVI variable when comparing patients to all census tracts in the United States was 0.31 (range 0.00 least vulnerable to 0.98 most vulnerable). CONCLUSIONS: Virtual visits were utilized by patients of all ages and gynecologic cancer types. African Americans were the most socially vulnerable patients of the cohort. Telemedicine is a useful platform for cancer care across the social vulnerability spectrum during the pandemic and beyond. To ensure continued access, further research and outreach efforts are needed.


Assuntos
COVID-19/prevenção & controle , Neoplasias dos Genitais Femininos/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Idoso , Americanos Asiáticos/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Estudos de Coortes , Controle de Doenças Transmissíveis/normas , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Ginecologia/organização & administração , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Oncologia/organização & administração , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Fatores Socioeconômicos , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos/epidemiologia
20.
Expert Rev Respir Med ; 15(6): 773-779, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33798401

RESUMO

Introduction: Bronchoscopy and related procedures have unambiguously been affected during the Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS COV-2). Ordinary bronchoscopy practices and lung cancer services might have changed over this pandemic and for the years to come.Areas covered: This manuscript summarizes the utility of bronchoscopy in COVID-19 patients, and the impact of the pandemic in lung cancer diagnostic services, in view of possible viral spread during these We conducted a literature review of articles published in PubMed/Medline from inception to November 5th, 2020 using relevant terms.Expert opinion: Without doubt this pandemic has changed the way bronchoscopy and related procedures are being performed. Mandatory universal personal protective equipment, pre-bronchoscopy PCR tests, dedicated protective barriers and disposable bronchoscopes might be the safest and simpler way to perform even the most complicated procedures.


Assuntos
Broncoscopia , COVID-19/epidemiologia , COVID-19/terapia , Infecção Hospitalar/prevenção & controle , Padrões de Prática Médica , Broncoscópios/microbiologia , Broncoscópios/normas , Broncoscópios/virologia , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/normas , COVID-19/prevenção & controle , COVID-19/transmissão , Contaminação de Equipamentos/prevenção & controle , História do Século XXI , Humanos , Neoplasias Pulmonares/diagnóstico , Oncologia/instrumentação , Oncologia/métodos , Oncologia/normas , Pandemias , Equipamento de Proteção Individual/virologia , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , SARS-CoV-2/fisiologia
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