Delays In Cancer Treatment Research Articles

Factors Contributing to Delay in Specialist Care After Colorectal Cancer Diagnosis in Kentucky

BackgroundAbundant studies have associated colorectal cancer (CRC) treatment delay with advanced diagnosis and worse mortality. Delay in seeking specialist is a contributor to CRC treatment delay. The goal of this study is to investigate contributing factors to 14-d delay from diagnosis of CRC on colonoscopy to the first specialist visit in the state of Kentucky. MethodsThe Kentucky Cancer Registry (KCR) database linked with health administrative claims data was queried to include adult patients diagnosed with stage I-IV CRC from January 2007 to December 2012. The dates of the last colonoscopy and the first specialist visit were identified through the claims. Bivariate and logistic regression analysis was performed to identify factors associated with delay to CRC specialist visit. ResultsA total of 3927 patients from 100 hospitals in Kentucky were included. Approximately, 19% of patients with CRC visited a specialist more than 14 d after CRC detection on colonoscopy. Delay to specialist (DTS) was found more likely in patients with Medicaid insurance (OR 3.1, P < 0.0001), low and moderate education level (OR 1.4 and 1.3, respectively, P = 0.0127), and stage I CRC (OR 1.5, P < 0.0001). There was a higher percentage of delay to specialist among Medicaid patients (44.0%) than Medicare (18.0%) and privately insured patients (18.8%). ConclusionsWe identified Medicaid insurance, low education attainment, and early stage CRC diagnosis as independent risk factors associated with 14-d delay in seeking specialist care after CRC detection on colonoscopy.

Melanoma Diagnostic Delay: Quantitative and Qualitative Measurement of COVID-19 Lockdown Effect

Background: The coronavirus disease 2019 (COVID-19) has led to a policy of severe restrictions for population in almost all countries hit by the pandemic. Italian National Health System were put hardly to the test by the pandemic. All the health system procedures not directly related to COVID-19 were reduced or suspended, and the access of patients to hospitals was limited. Any delay in cancer treatment has the real risk of patients' tumors progressing from being curable (with near-normal life expectancy) to becoming non-curable (with very reduced life expectancy). In particular, melanoma survival strictly depends on tumor thickness which, in turn, is a function of time. We aimed to examine the impact of the reduction of ordinary dermatologic face‐to‐face consultations activities on melanoma progression during COVID-19 Pandemic lock down. Methods: A retrospective observational cohort study was designed comparing clinical and histological characteristics of the primary melanomas removed in the first two months after lockdown conclusion (from May 1, 2020, through July 31, 2020) in twelve Italian centers specialized in the treatment of melanoma selected in geographical areas distinctly affected by COVID-19. The control group was composed by melanomas collected in the same period of the previous three years in the same centers. The primary outcome was the detection of quantitative and qualitative differences with respect to removed melanomas. Secondary outcome was to evaluate the impact on melanoma diagnosis of the lockdown measures in different Covid-19 risk geographical areas. Findings: Overall 1124 melanoma were collected from the participating centres, of these 237 were in the study group (2020-post lockdown period) while 887 were in the control group ( respectively 298 melanomas in 2017, 288 in 2018 and 301 in 2019; with an average of 295 melanomas per study period). We found a reduction by 20 % of the numbers of melanomas excised between the post COVID period and the same period of the previous years. Breslow thickness was increased for all melanoma cases in 2020 period compared to the same period of previous years. The Breslow thickness median increased from 0.4 to 0.5 mm (0.4mm vs 0.5mm, 0.5 mm vs 1.1mm, 0.3mm vs 0.9mm respectively for nothern, centre and south Italy). Ulcerated and high mitotic index melanomas (˃4 mitosis/mm2) increased in the 2020 post COVID group, particularly in northern Italy. High risk histotypes and melanoma with vertical growth showed a significative increase in all geographical areas. Interpretation: Reduction of a timely adequate diagnosis and treatment of melanoma during lockdown in Italy has lead to a significative increase of the severity of melanomas. The worsening of melanoma parameters may lead to a "staging jump" for patients with a consequent increase in systemic treatments and ultimately in mortality. In cases of a COVID-19 second wave and eventually a new lockdown, efforts must be made to ensure access to dermatologic clinics for melanoma patients in order to prevent further delays in diagnosis.Funding Statement: None.Declaration of Interests: The authors state no conflict of interest.Ethics Approval Statement: The study was approved by the local ethic committee.

Social determinants of health in uterine cancer patients in Ontario: Association with disease presentation and outcomes

Objective: Delay in diagnosis and treatment of endometrial cancer may be associated with disease progression and impact management and outcomes. Social and cultural barriers influence recognition of symptoms and self-advocacy in seeking care. Associations between social determinants of health (SDH) and disease presentation, treatment, and prognosis have been shown in some health care systems. Our objective was to investigate these in Ontario’s universal access system.

Gynecologic oncology care during the COVID-19 pandemic at three affiliated New York City hospitals

BackgroundNew York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. MethodsA prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. ResultsAmong 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. ConclusionsMore than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.

Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women.

Breast cancer mortality is higher for Black and younger women. This study evaluated 2 possible contributors to disparities-time to treatment and treatment duration-by race and age. Among 2841 participants with stage I-III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality). Thirty-two percent of younger Black women were in the highest quartile of treatment duration (versus 22% of younger White women). Black women experienced a higher frequency of delayed treatment (adjusted relative frequency difference [RFD], 5.5% [95% CI, 3.2%-7.8%]) and prolonged treatment duration (RFD, 8.8% [95% CI, 5.7%-12.0%]). Low SES was significantly associated with treatment delay among White women (RFD, 3.5% [95% CI, 1.1%-5.9%]), but treatment delay was high at all levels of SES in Black women (eg, 11.7% in high SES Black women compared with 10.6% and 6.7% among low and high SES White women, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among Black women, but both low SES and more barriers were associated with treatment duration across both groups. Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.

Abstract PO-043: A prospective testing SARS-Cov-2/COVID-19 in cancer patients with antitumor treatment

Abstract Background: The oncology community faces unprecedented challenges in balancing a delay in cancer treatment against the risk for a potential COVID-19 infection and associated complications. An early retrospective analysis reported that cancer patients with COVID-19 infection have a much higher death rate than those infected but without a cancer diagnosis, likely because of their immunocompromised disease from cancer and treatment. Even though COVID-19 is known to have a long incubation period (~14 days), there were no clear guidelines for screening asymptomatic cancer patients who are planning to have and having antitumor treatment as of April 2020. Methods: We developed a protocol to screen asymptomatic cancer patients for COVID-19 who are scheduled to receive cancer-directed treatment (i.e., chemotherapy, targeted therapy, immunotherapy, anticancer monoclonal antibody, endocrine therapy, or investigational agent). The protocol was developed and activated within 2 weeks through the Cancer Center Investigator Initiated Trial Program. FDA-authorized CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel EUA kit was performed at Sinochips Diagnostics. The primary objective was to determine COVID-19 status in participants prior to initiating anticancer treatment. The secondary objective was to evaluate COVID-19 related adverse events (AEs) in recovered COVID-19-positive participants for 30 days after initiation of anticancer therapy. Results: We enrolled 507 patients and tested for COVID-19 from 4/28/20 to 5/8/20 through coordinated efforts within the CTO and Biospecimen Repository Core Facility. The research study was stopped when the KU Health System was able to test this population as standard of care. Median age was 65 years, 110 patients (22%) were aged 75 years or older, and 274 (54%) patients were female. 387 patients (76.3%) were Caucasians, 35 (6.9%) African American, 7 (1.4%) Asian, and 437 (86.2%) non-Hispanic. Based on the catchment of zip codes, 7% of tested patients came from more than 60 miles and 1.6% from more than 100 miles. Zero patients had a positive COVID-19 test. Conclusions: The prevalence of COVID19 in asymptomatic cancer patients is low, likely because of good compliance with the social distance policy. Screening for COVID19 may help reduce AEs related to COVID-19 in patients receiving cancer-directed treatment. Studying COVID-19 test results in a larger patient pool is warranted. A similar study to test asymptomatic patient-facing oncology staff is pending. Citation Format: Kathan D. Mehta, Elizabeth Wulf-Burchfield, Natalie Streeter, Anup Kasi, Adam H. AlDouri, Roy Jensen, Andrew K. Godwin, Terry Tsue, Weijing Sun. A prospective testing SARS-Cov-2/COVID-19 in cancer patients with antitumor treatment [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-043.

Abstract PO-024: Incidence of SARS-COV-2 infection in cancer patients undergoing active treatment

Abstract Introduction and Objectives: Cancer patients are more susceptible to infections because of the active treatment that they need to treat their disease. A new coronavirus, called SARS-CoV-2, has caused a global pandemic where cancer patients have an increased risk of morbidity and mortality associated with COVID-19. However, the incidence data of COVID-19 in cancer patient with active treatment are not known, although the main oncology societies recommend a delay and/or stop in active cancer treatment during this pandemic. Whether this stop will have an impact on the future evolution of their disease is also not known. Therefore, a study of the incidence of COVID-19 in this type of patient can help us to organize the protocols and the treatment in these high-risk patient group. Materials and Methods: We conducted a prospective clinical study of cancer patients within active treatment (chemotherapy, palliative hormonotherapy, radiotherapy, target therapies, or immunotherapy), analyzing the number of COVID-19 diagnoses between February 26 and May 13 in two oncology services of the Andalusian community. A descriptive analysis of 692 patients with active treatment was carried out. In addition, the cumulative incidence and the differences between groups were calculated using the SPSS vs 18. Results: A total of 692 cancer patients undergoing active treatment at the Hospital Costa del Sol (Marbella) and at the Hospital San Cecilio (Granada) were analyzed. Sixty four percent were men with a mean age of 60 years. Forty one percent had a breast cancer diagnosis, 12.9% had lung cancer, and 14.5% had colorectal tumor. Fifty three percent of them received treatment for stage IV disease, and up to 43% were delayed treatment due to pandemic. The total number of infections was 9, a cumulative incidence of 1.3%, 95% CI (0.384-2.217), and 22% of them died after developing the infection. Advanced age (p = 0.011), an admission in the 3 months prior to the diagnosis of COVID-19 (p = 0.031), and active treatment with chemotherapy (p = 0.003) were the factors that were associated with an increased risk of developing COVID-19. Conclusions: The incidence of SARS-CoV-2 in cancer patients on active treatment is low but the mortality is high, as previously reported for these patients. Given that the incidence of COVID-19 in patients with treatment is low, we cannot conclude any role of treatment delay in the development of COVID-19 in these patients. Citation Format: Celia Martin Bravo, Isabel Blancas López-Barajas, Raúl Quirós López, Marta Robles Lasarte, Rosa Villatoro Roldán, Julia Alcaide García, Victor Navarro Pérez, Diego Perez Martín, Irene Zarcos Pedrinaci, Elisa Mañas Mora, Nicolás Jiménez García, Santiago Vico Cabra, Irati de Urrutia Undabarrena, Isabel Barragan Mallofret, Cristina Quero Blanco, Elisabeth Pérez-Ruiz. Incidence of SARS-COV-2 infection in cancer patients undergoing active treatment [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-024.

Letter of response to comments on: Developing a risk assessment score for patients with cancer during COVID-19 pandemic: A war on two fronts

Letter of response to comments on: Developing a risk assessment score for patients with cancer during COVID-19 pandemic: A war on two fronts

Impact of COVID-19 pandemic on clinical and surgical breast cancer management.

Impact of COVID-19 pandemic on clinical and surgical breast cancer management.

1721P Prolonged positive SARS-CoV-2 RT-PCR in cancer outpatients requires specific reorganization of cancer centres

Patients with cancer are more susceptible to infection because of immunosuppressive treatment given to cure cancer. Several guidelines published at the beginning of the COVID-19 pandemic recommend delaying systemic anticancer treatment until complete resolution of COVID-19 symptoms. In addition, it is important to segregate patients with cancer from patients with COVID-19 to avoid transmission. Nevertheless, some patients will present both diseases, and the duration of eviction from cancer units and delay of cancer treatment after COVID-19 remains unclear.

Suboptimal declines and delays in early breast cancer treatment after COVID-19 quarantine restrictions in China: A national survey of 8397 patients in the first quarter of 2020.

BackgroundCancer patients had been profoundly affected by the outbreak of COVID-19 especially after quarantine restrictions in China. We aimed to explore the treatment changes and delays of early breast cancer (EBC) during the first quarter of 2020.MethodsWe did this retrospective, multicentre, cohort study at 97 cancer centres in China. EBC patients who received treatment regardless of preoperative therapy, surgery or postoperative therapy during first quarter of 2020 were included.Findings8397 patients were eligible with a median age of 50 (IQR 43–56). 0·2% (15/8397) of EBC patients were confirmed as COVID-19 infection. Only 5·2% of breast cancer diagnosis occurred after quarantine in Hubei compared with 15·3% in other provinces (OR= 0·30, 95%CI 0·24–0·38). postoperative endocrine therapy were least affected compared with different regions after quarantine (OR=0·37 [95%CI 0·19–0·73]). The proportion of surgery decreased from 16·4% in December last year to 2·6% in February in Hubei. Compared with intervals from diagnosis to treatment before quarantine restrictions, the average time increased with significance from 3·5 to 7·7 days in Hubei and 5·7 to 7·7 days in other provinces (p< 0·001). There were also 18·5 and 7·2 days delay in Hubei and other provinces respectively when calculating interval from surgery to postoperative therapy.InterpretationEBC from high risk regions had a comparative rate of COVID-19 infection. After implementation of COVID-19 quarantine restrictions, fewer diagnosis and surgery with significant delays were seen when compared with treatment before.FundingBeijing Medical Award Foundation (YJ0120)

Impact of active tuberculosis on treatment decisions in cancer

Background Tuberculosis (TB) and cancer can coexist in some patients especially from low- and middle-income countries. Impact of active TB on treatment decisions in cancer is less well studied. Methods A retrospective case record review of all cases of cancer diagnosed and or treated between January 2012 and December 2019 who were also diagnosed to have active TB (pulmonary or extrapulmonary) was done. Results Any delay or change in standard treatment of cancer because of active TB or its treatment was noted. Among a total of 32,509 cancer cases, 56 (0.17%) patients were diagnosed to have active TB. Twenty six patients (46%) had delay in starting treatment or delay during cancer treatment. Six (11%) patients were changed from curative treatment option to palliative intent (either best supportive care or palliative Radiation) or no further treatment. Three (5%) patients required change from one type of curative treatment modality to another curative option. Conclusion Eleven percent of patients had to be changed from curative intent to palliative treatment or no further treatment, TB being either the direct or indirect cause in all of them. A nationwide data registry of cancer patients with TB, involving multiple centers, should be considered so that specific problems in this context can be identified and addressed in larger details.

Impact of COVID-19 pandemic on lung cancer treatment scheduling.

The current coronavirus disease 2019 (COVID‐19) pandemic is associated with a heavy burden on the mental and physical health of patients, regional healthcare resources, and global economic activity. Many patients with lung cancer are thought to be affected by this situation. Therefore, in this study, we aimed to evaluate the impact of COVID‐19 pandemic on lung cancer treatment scheduling. We retrospectively reviewed the medical records of lung cancer patients who were undergoing anticancer treatment at the National Hospital Organization Kyoto Medical Center (600 beds) in Kyoto, Japan, between 1 March 2020 and 31 May 2020. After the medical records were reviewed, the patients were assigned to one of two groups, depending on whether their lung cancer treatment schedule was delayed. We assessed the characteristics, types of histopathology and treatment, and the reason for the delay. A total 15 (9.1%) patients experienced a delay in lung cancer treatment during the COVID‐19 pandemic. Patients with a treatment delay received significantly more immune checkpoint inhibitor (ICI) monotherapy than patients without a treatment delay (P = 0.0057). On the contrary, no patients receiving molecular targeted agents experienced a treatment delay during the COVID‐19 pandemic period (P = 0.0027). The treatments of most of the patients were delayed at their request. We determined that 9.1% lung cancer patients suffered anxiety and requested a treatment delay during the COVID‐19 pandemic. Oncologists should bear in mind that patients with cancer have more anxiety than expected under unprecedented circumstances such as the COVID‐19 pandemic.

Patient Falls Prevention: Assessing the Use of an Innovative Color-Coded Flag System in an Outpatient Oncology Infusion Center.

The National Database of Nursing Quality Indicators (NDNQI, 2020) defines a patient fall as an unplanned descent to the floor with or without injury. A fall occurs in 30%-50% of hospitalized patients with cancer in the United States (Jatoi, 2017). According to the Joint Commission (2015), the average cost of each fall with injury in the United States was about $14,000 to the healthcare system, averaging about $50 billion annually (Kartiko et al., 2020). Fall-related injuries to patients can result in additional treatment, hospital admissions, prolonged hospital stays, delays in cancer treatment, immobility, pain, emotional distress, caregiver fatigue, and depression (Joint Commission, 2015). Patients with cancer are highly susceptible to falls because of the neurologic deficits caused by chemotherapy treatments, medications given to prevent side effects, allergic reactions to the chemotherapy medications, increasing age, cognitive status, disease site, and cancer- and treatment-related fatigue (Jatoi, 2017). The high financial costs to patients and healthcare providers, as well as the physical and mental impact on patients, led to this pilot project.

Patient and health service factors associated with delays in cancer treatment for children without social security in Mexico.

The objective was to investigate factors associated with patient-related timing (PRT) to seek healthcare and health service-related timing (HSRT) to diagnose cancer and provide treatment to children without social security in Mexico. A cross-sectional survey was conducted in 13 Ministry of Health hospitals in the states of Chihuahua, Jalisco, Mexico City, Morelos, Oaxaca, Puebla, Queretaro, State of Mexico, and Tlaxcala. Study participants were parents of recently diagnosed pediatric cancer patients (≤ 17 years of age). Three groups of factors were investigated: (1) patients (child and parent characteristics); (2) healthcare providers (HCPs) (first-contact HCP, institution, perceptions of barriers to healthcare, etc.); and (3) disease factors (cancer type/site, stage/risk at diagnosis). PRT and HSRT-associated factors were identified using multiple negative binomial regressions. The study included 265 children; 49% sought care when symptoms first appeared. The median PRT was seven days, and the median HSRT was 40 days. Parents' perceptions of long wait times for appointments were associated with longer PRT and HSRT. Residing in the lowest or highest socioeconomic regions and persistent or worsening symptoms increased the probability of longer PRT. Older patient age, HCP requests for imaging tests or prescription for steroids, a higher number of doctors consulted, having a urinary tract cancer, and having an advanced stage or high-risk cancer increased the probability of longer HSRT. Strategies to shorten lag time from symptom onset to diagnosis and treatment are urgently needed for childhood cancers in Mexico.

Life of an Oncologist after COVID-19 Pandemic

Coronavirus disease 2019 (COVID - 19) crisis led to a significant strain on oncological services with reallocation of resources towards Coronavirus infection. Assessment of the risk-benefit ratio and prioritization of cancer patients was necessary. In the absence of a vaccine, drug or presence of a herd immunity (as a result of disease transmission), it was a like a double-edged sword for cancer patients, where they had to choose between either an increasing risk of infection transmission or a delay in cancer treatment for mitigation of Coronavirus infection. Academic activities, trainings, examinations (theoretical/practical) and all research activities were put on hold. Timely delivery of surgery, radiotherapy or chemotherapy was delayed even for patients with curative cancer. Current pandemic offered an opportunity towards increasing the awareness and adoption of virtual technological innovations to interact and educate, formulate clinical guidelines, researching newer modalities and drugs and promoting a great sense of mutual understanding and collaboration among healthcare workers all over the globe.

The effect of 1-day multidisciplinary clinic on breast cancer treatment.

A delay in breast cancer treatment is associated with inferior survival outcomes; however, no clear guidelines exist defining the appropriate time frame from diagnosis to definitive treatment of breast cancer. A multidisciplinary approach for breast cancer treatment can minimize the time from diagnosis to first treatment. We hypothesized single-day multidisciplinary clinic (MDC) may accelerate the time to first treatment on complex breast cancer cases at our institution. We identified patients who were treated at Johns Hopkins for stage II or III breast cancer, who were at least 18years of age, and were seen in a new single-day MDC with coordination between two or three specialties or by specialists from varying disciplines on different days (IDC). Patients who initiated treatment between May 2015 (initiation of MDC clinic) and December 2017 were included in our study. A total of 296 patient records were reviewed independently. The mean (SD) patient age was 55 (13) years. The median time to first neoadjuvant chemotherapy (NACT) was significantly reduced for patients seen in the MDC (12.7days), compared to those seen at the IDC (24.4days, logrank p < 0.001). The median time to definitive surgery was similar between groups (31 and 32days for the MDC and IDC cohorts, respectively). A single-day MDC visit is associated with a reduced time from diagnosis to NACT. Further studies are needed to determine if a shorter interval can improve the management and the outcome of complex breast cancer cases.

Abstract B124: Breast cancer treatment delays at an urban safety net hospital among women experiencing homelessness

Abstract Abstract Disparities in outcomes for vulnerable women is a persistent, ongoing problem. Timely treatment improves breast cancer outcomes and efforts to improve delays among underserved patients is needed. Specifically, homelessness and breast cancer treatment outcomes are understudied. This is a novel and descriptive study exploring types of homelessness and treatment delays at an urban safety net hospital providing care to a vulnerable patient population. Experimental Procedures This study is a retrospective chart review of homeless female patients diagnosed with breast cancer between January 1, 2000 and December 31, 2014. Data for this study were acquired from the hospital cancer registry and electronic medical record. Homelessness was categorized as transitionally, episodically or chronically homeless. Other variables collected included demographic characteristics and time to treatment. A detailed chart review was conducted to identify delays to breast cancer treatment and the potential reasons for delay between diagnosis and first treatment. All demographic characteristics, time to treatment and factors related to delays to treatment were analyzed descriptively, reporting frequencies and proportions. Delay to treatment was calculated as date of pathologically confirmed biopsy of breast cancer to date of first treatment (surgery or chemotherapy). Summary of Data The total number of individuals analyzed was 24. All except two subjects were delayed to treatment (&amp;gt; 30 days from diagnosis to treatment). Most women in this cohort were categorized as chronically homeless (46%) with the rest categorized as transitionally (29%) or episodically (12%) homeless. The majority of subjects (70%) were Black, non-Hispanic. Most women identified as single (58%) or divorced (21%) at the time of breast cancer diagnosis. All except one subject were publicly insured (71% Medicaid; 12% Medicare) or uninsured (8%). Regardless of type of homelessness, most subjects were either 30-60 or 60-90 days delayed. Those who were chronically homeless experienced significantly more delays to first treatment (56% of those who were delayed 30-60 days and 57% of those who were delayed 60-90 days; p-value 0.006) than those who were episodically or transitionally homeless. Conclusions Significant delays and barriers to breast cancer treatment exist among women experiencing homelessness. Further studies and focused efforts to improve timely breast cancer care for homeless women is warranted. Citation Format: Kate Festa, Ariel E Hirsch, Michael R Cassidy, Lauren Oshry, Kathryn Quinn, Margaret M Sullivan, Naomi Y Ko. Breast cancer treatment delays at an urban safety net hospital among women experiencing homelessness [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B124.

International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review.

BackgroundDuring the COVID-19 pandemic, surgical departments were forced to re-schedule their activity giving priority to urgent procedures and non-deferrable oncological cases. There is a lack of evidence-based literature providing clinical and organizational guidelines for the management of a general surgery department. Aim of our study was to review the available recommendations published by general Surgery Societies and Health Institutions and evaluate the underlying Literature.Materials and methodsA review of the English Literature was conducted according to the AMSTAR and to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.ResultsAfter eligibility assessment, a total of 22 papers and statements were analyzed. Surgical societies have established criteria for triage and prioritization in order to identify procedures that can be postponed after the pandemic and those that should not. Prioritization among oncologic cases represents a difficult task: clinicians have to balance a possible delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure. There is broad agreement among guidelines that indication to proceed with surgery should be discussed in virtual Tumor Boards taking into consideration alternative therapeutic approaches. Several guidelines deal with the role of laparoscopic surgery during the pandemic: a tailored approach is currently suggested, with a case-by-case evaluation provided that appropriate personal protective equipment is available in order to minimize the potential risk of transmission. Finally, there is a considerable agreement in the published Literature concerning the management of the personnel during the peri- and intraoperative phase and on the technical advices regarding the induction, operative and recover maneuvers in COVID-19 cases.ConclusionsDuring COVID-19 pandemic, it is of paramount importance to face the emergency in the most effective and efficient manner, retrieving resources from non-essential settings and, at the same time, providing care to high priority non-COVID-19 related diseases.

Using multiple perspectives analysis to propose state cancer control policy in Abia State, Nigeria.

e14132 Background: Beyond the National Cancer Control Plan, most States in Nigeria do not have State cancer control policies. Using the multiple perspectives analysis framework, this research sought to explore the perspectives of patients diagnosed with cancer, healthcare providers and health policymakers regarding cancer policy in Abia State. Methods: A concurrent mixed methods action research design was used. Sample included individuals aged ≥18 years who were diagnosed with cancer (patients), provided cancer treatment (providers) or made health policy (policymakers) in the State. Data were collected using surveys and key informant interviews. Data analysis involved descriptive statistics, chi-square test and a deductive thematic analysis. Results: Participants were 29 patients, 50 providers and 33 policymakers (n = 122), with an average age of 45 (±11) years. Challenges identified by ≥60% of participants were: low public awareness (75.9%); limited availability of treatment options (62.6%); lack of treatment pathways (92.8%); lack of local cancer data (95.2%); and, absence of support groups for patients (88.0%). Each group of participants (n = 3) rated cancer 9 out of 10 as a public health priority. Some qualitative themes were: low cancer awareness, delays in cancer treatment and financial burden on patients. “One thing I’d like to include in the policy is to make cancer a reportable disease in the State.” -Policymaker. Most participants (80%, 90/112) recommended that health insurance should fund ≥16% of cancer control activities, although policymakers were more likely to make quarterly insurance contributions than patients (7 out of 10 vs. 5 out of 10). Conclusions: Cancer control was an important issue for people in the State. Inadequate prevention services with a background of &gt; 3-month diagnostic delays, characterized cancer control in Abia State. Future cancer control policy should emphasize cancer prevention, the creation of local clinical pathways and a blended financing model. [Table: see text]