COVID-19 pandemic: The new normal in breast cancer management - prioritization of care from a breast surgical unit's experience in Singapore.
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ABSTRACT:
SUBMITTER: Tan SM
PROVIDER: S-EPMC7547643 | biostudies-literature | 2021 Jan
REPOSITORIES: biostudies-literature
Publications
COVID-19 pandemic: The new normal in breast cancer management - prioritization of care from a breast surgical unit's experience in Singapore.
Tan Su-Ming SM Melissa Seet Yert Li YL Mok Chi Wei CW
Asian journal of surgery 20201010 1
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Project description:IntroductionDiagnostic Radiographers (DR) are the frontline responders during the COVID-19 outbreak, providing essential diagnostic imaging services for screening and monitoring of suspected and confirmed patients. Understanding the experience and perceptions of DR towards the COVID-19 outbreak enables radiography leaders to guide changes in the approach to managing response to future health outbreaks. This study aims to document the experiences of DR in Singapore during the COVID-19 pandemic.MethodsAll DR practising in Singapore institutions were invited to participate in an online survey, disseminated by the Singapore Society of Radiographers (SSR). The survey assessed the attitudes and perceptions of the respondents on the COVID-19 pandemic. The Holmes and Rahe Stress Scale was used to identify the respondents' life events closely related to the pandemic. Data collection took place from 5 July 2020 to 5 September 2020.ResultsA total of 123 DR responded to the survey, where 89.4% of the respondents had been involved in the imaging of suspected or confirmed COVID-19 patients. Those performing General Radiography had the highest number of cases - 300 cases a month. The fear of transmitting COVID-19 to their family presented as the primary stressor (77.2%), followed by the lack of manpower (73.2%). The global themes that emerged from the study were (1) adapting to change and (2) quality of support.ConclusionRadiology departments in Singapore were able to cope with the high demands of the pandemic in terms of the provision of information, supplies, and physical equipment. However, they were less prepared to handle human factors such as mental health and staff morale. The safety and well-being of staff should not be compromised to reduce staff anxiety while performing their duties. Strategies to improve their ability to adapt to changes and provision of quality support are necessary measures in future pandemic situations.
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Project description:Preventive health behaviors such as hand hygiene are crucial amidst pandemics like COVID-19 but reports on nonadherence persist. This could be due to the lack of Consideration of Future Consequences (CFC), a cognitive-motivational construct known to improve health-related behaviors. Therefore, we examined the relationship between CFC and five behaviors-mask-wearing, social distancing, hand hygiene, excessive necessities buying, and COVID-19 information searching using an internet-based Singapore-wide survey conducted from April 20 to May 4, 2020. Behavioral differences 2 weeks before and after the state-wide confinement were examined using paired t-tests. Relationships between CFC and COVID-19 behaviors were examined using regression analyses adjusted for depression and anxiety. Participants were regrouped into three categories-increased behavior performance, maintained high performance, and maintained low performance where mean differences were analysed using MANOVA. Three hundred and thirty-six participants completed the survey (mean age, SD = 32.9 years [SD = 12.6]; 38.7% males). CFCfuture predicted mask wearing (B = 0.16; p < .05), social distancing (B = 0.0.19; p < .01), hand hygiene (B = 0.17; p < .01), and information searching (B = 0.21; p < .001). CFCimmediate predicted hand hygiene (B = 0.09; p < .05), excessive necessities buying (B = 0.07; p < .05) and information searching (B = 0.08; p < .05). Anxiety predicted excessive buying (B = 0.08; p < .05) and hand hygiene (B = 0.13; p < .01). Post-hoc test showed significantly higher CFCfuture (p < .01) in participants who increased and maintained high behavioral performance.
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Project description:COVID-19, also known as the coronavirus disease 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) declared pandemic by the World Health Organization (WHO). As the world faces the coronavirus disease 2019 crisis, the oncology community is being impacted by unprecedented challenges. During this trying time, patients with ovarian cancer (OC) have been affected by a delay in diagnosis, surgery, chemotherapy and radiation treatments, and oncology follow-ups being conducted via telemedicine instead of in-person visits. OC patients and their oncologists are balancing the fears of COVID-19 and cancer treatment with the consequences of delaying cancer care. The delay in treatment care that women with OC are experiencing has resulted in higher levels of cancer worry, anxiety, and depression. In this article, we succinctly review the impact of the COVID-19 pandemic on the diagnosis and treatment and ongoing clinical trials of OC. We also discuss the psychological effects of COVID-19 on women with OC and alternative therapeutic strategies to limit in-person hospital visits to reduce the spread of the disease, and the impact of COVID-19 on OC patients.
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Project description:One hundred and five patients of surgical obstructive jaundice were admitted to Army Hospital, Delhi from July 1991 to June 1994. Patients were investigated as per the diagnostic protocol. The causes of obstruction were choledocholithiasis (24 patients), periampullary carcinoma and carcinoma head of pancreas (32 patients), carcinoma gall bladder and cholangiocarcinoma (11 patients each). The procedures performed to relieve obstructive jaundice in 89 cases included choledochojejunostomy (17), pancreato-duodenectomy (15), hepaticojejunostomy (15), choledocholithotomy (12) and choledochoduodenostomy (12). Mortality was 7 per cent in pancreatoduodenectomy and 8 per cent in palliative procedures.
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Project description:Of 400 patients with hilar cholangiocarcinoma who were treated at Nagoya University Hospital from 1977 to 2004, 301 (75%) underwent surgical resection. Most patients underwent major hepatectomy with extrahepatic bile duct resection. The overall mortality rate was 7.6% but had decreased to 2.5% in the last 5 years (p=0.007). The overall survival rates at 5, 10 and 15 years were 22%, 13% and 10%, respectively. The survival rates of 233 patients undergoing R0 resection were 27%, 16% and 13%, respectively. R1 or R2 resection, lymph node metastasis and portal vein involvement were significant negative prognostic factors, although survival was better than in patients with unresected tumours. The results show that aggressive surgical treatment of hilar cholangiocarcinoma offers good outcomes with an acceptable mortality rate.
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Project description:IntroductionThe resource burden of healthcare disputes and medico-legal claims has been rising. A dispute resolution system operating at the hospital level could ameliorate this disturbing trend.MethodsThis is a retrospective observational study on patient complaints and medico-legal cases received by the dispute resolution unit of an acute tertiary hospital from 2011 to 2015. We described the characteristics and analysed the resolution methodology and outcomes of all closed medico-legal cases.ResultsPatient complaints significantly increased at a compound annual growth rate (CAGR) of 4.2% (p<0.01), while medico-legal cases and ex-gratia payments for case settlements decreased at CAGRs of 4.8% (p<0.05) and 15.9% (p = 0.19), respectively. Out of 237 closed medico-legal cases, 88.6% were resolved without legal action, of which 78.1% were closed without any ex-gratia payments or waivers. Of the 11.4% of medico-legal cases that involved legal action, 66.7% were settled without ex-gratia payments or waivers. The primary resolution modes were the Patient Relations Service (PRS)'s engagement of the complainants and facilitation of written replies. No cases were brought to court. Cases were more likely resolved without legal action when there was engagement by the PRS (p = 0.009). These cases incurred a lower median settlement value than those with legal action.ConclusionOur hospital-based dispute resolution system which addressed patients' core dissatisfactions and providers' perspectives, through a process of early engagement, open disclosure, and fair negotiations, was able to promote claims resolution before legal action was taken. This early dispute resolution strategy contained costs and maintained provider-patient relationships and complements system-level mediation and arbitration to reduce medico-legal litigation.
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Project description:BackgroundTelemedicine was adopted to minimize exposure risks for patients and staff during the coronavirus disease 2019 pandemic. This study measured patient satisfaction and telemedicine usability in breast cancer care.MethodsAdult breast cancer patients who had a telemedicine visit at a single academic institution (with surgical, radiation, or medical oncology) from 15 June 2020 to 4 September 2020 were surveyed anonymously. Patient and cancer characteristics were collected, and patient satisfaction and telemedicine usability were assessed using a modified Telehealth Usability Questionnaire with a 7-point Likert scale. Associations of satisfaction and usability with patient characteristics were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests.ResultsOf 203 patients who agreed to be contacted, 78 responded, yielding a response rate of 38%. The median age of the respondents was 63 years (range 25-83 years). The majority lived in an urban area (61%), were white (92%), and saw a medical oncologist (62%). The median patient satisfaction score was 5.5 (interquartile range [IQR] 4.25-6.25). The median telemedicine usability score was 5.6 (IQR 4.4-6.2). A strong positive correlation was seen between satisfaction and usability, with a Spearman correlation coefficient (ρ) of 0.80 (p < 0.001). Satisfaction and usability scores did not vary significantly according to patient age, race, location of residence, insurance status, previous visit commute time, oncology specialty seen, prior telemedicine visits, or whether patients were actively receiving cancer treatment.ConclusionsBreast cancer patients were satisfied with telemedicine and found it usable. Patient satisfaction and telemedicine usability should not limit the use of telemedicine in future post-pandemic breast cancer care.
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Project description:IntroductionThe COVID-19 pandemic had a profound impact on health-care systems and reduced access to care. This study assays the mid-term effects of the COVID-19 pandemic on breast cancer management over a 2-year-period in a single French Comprehensive Cancer Center.MethodsWe performed, in a French comprehensive cancer center, an observational study including all patients with newly diagnosed breast cancer between 2019 and 2021. We collected the number of first consultations for breast cancer, the number of breast and axillary surgeries, pTNM and ypTNM cancer staging, the therapeutic sequence (surgery or neoadjuvant chemotherapy as a primary treatment), patients' age and their place of residence.ResultsIn total, 14,772 patients had a first consultation for breast cancer. Among these 9058 breast and axillary surgeries were performed, 1798 patients had neoadjuvant chemotherapy as a primary treatment. During the first COVID-19 lockdown ( March17, 2020-May 10, 2020), we observed a reduction in the number of first consultations for breast cancer and breast cancer surgeries giving respectively a 42.3% and 27% rate of change. Subsequently, we observed a resumption of consultations and surgeries with a slight increase in early 2021 compared to 2019. In addition, we did not find any difference in terms of therapeutic sequence, pTNM and ypTNM stages, age at diagnosis or place of residence between the reference year 2019 and the years 2020 and 2021.ConclusionOur study shows a decrease in activity during the first lockdown of 2020, then a resumption of activity. These reassuring results only concern patients with breast cancer, and are specific to our institution, whose oncology activity was preserved during the COVID-19 pandemic.
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