Oncologic Conditions Research Articles

Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

BackgroundDuring the COVID-19 pandemic, reductions in healthcare utilization are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities in access to healthcare in the context of COVID-19.MethodsTo evaluate gender disparities in access to medical in Chile we conducted an interrupted time series analysis using segmented regression. The outcome variable was the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. The series contained data from weeks 1 to 39 for 2017 to 2020. The intervention period started at week 12. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. We estimated the level effect using a dummy variable indicating the intervention period and slope effect using a continuous variable from weeks 12 to 39. To test heterogeneity by gender and age group, we conducted a stratified analysis.ResultsWe observed a sizable reduction in access to care with a slowly recovery for oncologic (level effect 0.323; 95% CI 0.291–0.359; slope effect 1.022; 95% CI 1.016–1.028) and cardiovascular diseases (level effect 0.586; 95% CI 0.564–0.609; slope effect 1.009; 95% CI 1.007–1.011). Greater reduction occurred in women compared to men, particularly marked on myocardial infarction (level effect 0.595; 95% CI 0.566–0.627 versus 0.532; 95% CI 0.502–0.564) and colorectal cancer (level effect 0.295; 95% CI 0.248–0.35 versus 0.19; 95% CI 0.159–0.228). Compared to men, a greater absolute reduction was observed in women for oncologic diseases, excluding sex-specific cancer, (1352; 95% CI 743–1961) and cardiovascular diseases (1268; 95% CI 946–1590).ConclusionWe confirmed a large drop in new diagnoses for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response.

Underutilization of Palliative Care for Patients with Advanced Peripheral Arterial Disease

Advanced peripheral arterial disease is associated with an overall annual mortality between 20-40%. Amputees are at particularly high risk for perioperative and long-term mortality and may benefit from palliative care programs to improve quality of life and to align medical treatments with their goals of care. As studies of palliative care in vascular patients are scarce, we sought to examine palliative care utilization using below knee amputation (BKA) as a surrogate for advanced peripheral arterial disease. All patients who underwent below knee amputation over a 5-year period at a single large academic medical center were identified through chart review. Demographics, preoperative conditions, intraoperative factors, and perioperative outcomes were recorded. The primary outcome was palliative care consultation at the time of the amputation. The secondary outcomes included one-year mortality and palliative care consultation prior to death. The cohort comprised 111 patients (76 men, 35 women) who received BKA for chronic limb threatening ischemia. Three patients (2.7%) received palliative care consultations at the time of their amputation. Of these, one had been obtained remotely for an oncologic condition and the others for surgical decision-making. Follow-up was available for 73 patients. One-year mortality was 21.9% (n=16) at a mean of 102 ± 86 days after BKA. Among patients who died within 1 year of their amputation, 37.5% (n=6) received palliative care consultations prior to their death. The median interval between amputation and palliative consultation was 26 (IQR 14-81) days. The median interval between palliative consultation and death was 9 (IQR 4-39) days. Palliative care services were rarely provided to patients with advanced peripheral arterial disease. When obtained, consultations occurred closer to death than to amputation suggesting a missed opportunity to receive the benefits of early evaluation. Future studies can be aimed at identifying a cohort of vascular patients who would most benefit from early palliative evaluation and determining if palliative consultations alter health care utilization patterns and outcomes for vascular patients.

Intermittent fasting in the prevention and treatment of cancer.

Chronic caloric restriction (CR) has powerful anticarcinogenic actions in both preclinical and clinical studies but may be difficult to sustain. As an alternative to CR, there has been growing interest in intermittent fasting (IF) in both the scientific and lay community as a result of promising study results, mainly in experimental animal models. According to a survey by the International Food Information Council Foundation, IF has become the most popular diet in the last year, and patients with cancer are seeking advice from oncologists about its beneficial effects for cancer prevention and treatment. However, as discussed in this review, results from IF studies in rodents are controversial and suggest potential detrimental effects in certain oncologic conditions. The effects of IF on human cancer incidence and prognosis remain unknown because of a lack of high-quality randomized clinical trials. Preliminary studies suggest that prolonged fasting in some patients who have cancer is safe and potentially capable of decreasing chemotherapy-related toxicity and tumor growth. However, because additional trials are needed to elucidate the risks and benefits of fasting for patients with cancer, the authors would not currently recommend patients undergoing active cancer treatment partake in IF outside the context of a clinical trial. IF may be considered in adults seeking cancer-prevention benefits through means of weight management, but whether IF itself affects cancer-related metabolic and molecular pathways remains unanswered.

28665 Cutaneous T-cell lymphoma (CTCL) outcomes during COVID-19

New York-Presbyterian Hospital and Columbia University Irving Medical Center were heavily impacted by the COVID-19 pandemic. Various measures were taken in an effort to ensure patient and staff safety. The management of patients with complex dermatological oncologic conditions, such as cutaneous T-cell lymphoma (CTCL) was especially challenging. We present a case review of patients diagnosed with CTCL who also had confirmed or suspected COVID-19 infection (n = 6). Diagnoses included were mycosis fungoides (n = 2), Sézary syndrome (n = 2), and primary cutaneous CD30+ lymphoproliferative disorder (n = 2).

Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database.

Racial disparities in outcomes after orthopaedic surgery have been well-documented in the fields of arthroplasty, trauma, and spine surgery; however, little research has assessed differences in outcomes after surgery for oncologic musculoskeletal disease. If racial disparities exist in the treatment of patients with pathologic long bone fractures, then they should be identified and addressed to promote equity in patient care. (1) How do wait times between hospital admission and operative fixation for pathologic fractures of long bones differ between Black and non-Hispanic white patients, after controlling for confounding variables using propensity score matching? (2) How does the proportion of patients with 30-day postoperative complication differ between these groups after controlling for confounding variables using propensity score matching? Using the National Surgical Quality Improvement Program database, we analyzed 828 patients who underwent fixation for pathologic fractures from 2012 to 2018. This database not only provides a large enough sample of pathologic long bone fracture patients to conduct the present study, but also it contains variables such as time from hospitalization to surgery that other national databases do not. After excluding patients with incomplete data (4% of the initial cohort), 775 patients were grouped by self-reported race as Black (12% [94]) or white (88% [681]). Propensity score matching using a 1:1 nearest-neighbor match was then used to match 94 Black patients with 94 white patients according to age, gender, BMI, American Society of Anesthesiologists physical status classification, anemia, endstage renal disease, independence in performing activities of daily living, congestive heart failure, and pulmonary disease. The primary outcome of interest was the number of days between hospital admission and operative fixation, which we assessed using a Poisson regression and report as an incidence risk ratio. The secondary outcomes were the occurrences of major 30-day postoperative adverse events (failure to wean off mechanical ventilation, cerebrovascular events, renal failure, cardiovascular events, reoperation, death), minor 30-day adverse events (reintubation, wound complications, pneumonia, and thromboembolic events), and any 30-day adverse events (defined as the pooling of all adverse events, including readmissions). These outcomes were analyzed using a bivariate analysis and logistic regression with robust estimates of variance and are reported as odds ratios. Because any results on disparities rely on rigorous control of other baseline demographics, we performed this multivariable approach to ensure we were controlling for confounding variables as much as possible. After controlling for potentially confounding variables such as age and gender, we found that Black patients had a longer mean wait time (incidence risk ratio 1.5 [95% CI 1.1 to 2.1]; p = 0.01) than white patients. After controlling for confounding variables, Black patients also had greater odds of having any postoperative adverse event (OR 2.1 [95% CI 1.1 to 3.8]; p = 0.02), including readmission (OR 3.3 [95% CI 1.5 to 7.6]; p = 0.004). The racial disparities in pathologic long bone fracture care found in our study may be attributed to fundamental racial biases, as well as systemic socioeconomic disparities in the US healthcare system. Identifying and eliminating the racial, socioeconomic, and sociocultural biases that drive these disparities would improve care for patients with orthopaedic oncologic conditions. One possible way to reduce these disparities would be to implement standardized surgical care pathways for pathological long bone fractures across different institutions to minimize variation in important aspects of care, such as time to surgical fixation. Further insight is needed on the types of standardized care pathways and the implementation mechanisms that are most effective. Level III, therapeutic study.

Did surgical delay due to COVD-19 affect the short- and longer-term mental health of patients?

Objectives:At the height of the COVID-19 pandemic, the US Surgeon General ordered the cessation of all elective surgical procedures. We evaluated the mental health impact of COVID-19 related surgical delay on patients awaiting procedures for benign, pre-malignant and malignant conditions. We sought to understand the short term impact of surgical delay and to identify potential longer term mental health affects after completion of the delayed procedure.Methods:All patients over age 18 awaiting surgery for benign, pre-malignant or malignant conditions in the gynecologic oncology, surgical oncology and colorectal services at Northwell Health were eligible. Upon enrollment, participants completed a baseline survey consisting of the Generalized Anxiety Disorder Questionnaire (GAD-7), the Penn State Worry Questionnaire (PSWQ), and Brief-Illness Patient Questionnaire (B-IPQ). Six weeks after their surgery, participants were sent a second survey consisting of the Center for Epidemiologic Studies Depression (CES-D) scale in addition to the GAD-7, PSWQ, and B-IPQ.Results:56 patients underwent their procedure and completed the follow-up survey. Patients with suspected benign conditions had a longer delay in scheduling their surgery than patients with suspected/confirmed cancer or pre-malignant conditions (101.4d vs 66.3d, p<0.05). There was no correlation of length of delay with postoperative worry, anxiety, or depression scores. There was no decrease in level of worry, as delineated by the PSWQ, among gynecologic oncology patients when comparing pre-operative to post-operative data. However, surgical oncology and colorectal patients demonstrated decreased post-operative worry. There was no difference in anxiety by surgical specialty.While the surgical delay was ongoing 79% of patients considered it to be moderately to extremely concerning, with 46% indicating the highest possible level of concern. Post-operatively, 47% of the respondents indicated moderate to extreme concern about the surgical delay, while 37% were not concerned. Initially, the surgical delay was considered to have a moderate to severe impact upon daily life by 65% of patients; which decreased to 53% at the time of post-operative follow-up. Interestingly, these relative decreases in patient concern were not significant when comparing pre-operative to post-operative values as a whole, by diagnosis or by specialty. 20% of participants qualified as depressed based on their response to the CES-D. Of these patients, 70% had a post-operatively confirmed cancer or pre-cancer. The incidence of depression was not affected by the post-operative diagnosis.Conclusions:Many patients experienced distress surrounding surgical delay due to the COVID-19 pandemic. This extended to their postoperative period. Gynecologic oncology patients did not experience decreased post-operative worry, while surgical oncology and colorectal patients did. There was no significant difference in the incidence of post-operative depression by specialty or post-operative diagnosis.

Comparison of mini laparotomy and morcellation for large specimen retrieval in robotic gynecologic surgery

<h3>Objectives:</h3> Minimally invasive surgery (MIS) is the standard of care for gynecologic and gynecologic oncology conditions. For large specimen retrieval, morcellation is a controversial option due to concerns of undetected malignancy and dissemination. Our objective was to compare safety and discharge outcomes for patients with mini-laparotomy (ML) versus morcellation for large specimen retrieval during robotic cases. <h3>Methods:</h3> In this retrospective cohort study of patients who underwent robotic gynecologic surgery (RGS) from January 2013 to June 2016, we compared intraoperative and postoperative outcomes for patients undergoing ML or morcellation. Mode of specimen delivery was at the discretion of the surgeon. The ML group consisted of patients who at the completion of RGS underwent an abdominal ML incision and the morcellation group consisted of patients who underwent manual or power morcellation for specimen delivery. Outcomes were analyzed using Mann-Whitney U test, Chi-squared/Fisher's exact tests, and multivariate logistic models. <h3>Results:</h3> Of the 2,126 patients undergoing RGS, 154 (7.2%) underwent a ML for specimen retrieval and 834 (39.2%) underwent specimen removal with morcellation. Median age was greater for the ML compared to morcellation (45 [IQR 37.1-52.8] vs 40 [IQR 35.0-46.0]; p<0.001), but median body mass index (26.1 [IQR 22.6-32.2] vs 25.7 22.6-30.2]; p=0.31) and proportion of patients with ≥3 comorbidities (9.1% vs 6.5%; p=0.32) were similar between groups. Twenty-one (13.6%) patients with ML were undergoing surgery for cancer diagnosis, compared to 1 (0.1%) patient with morcellation (p<0.001). Patients with ML had significantly heavier specimen weights, (median 386.3 g [IQR 245.0-641.0] vs 280.0 g [IQR 114.0-510.0]; p<0.001), estimated blood loss (EBL, median 122.5 mL [IQR 50.0-250.0] vs 100.0 mL [IQR 50.0-250.0]; p=0.03), and longer operative time (median 211.0 min [IQR 162.3-67.0] vs 178.0 min [IQR 135.0-233.7]; p<0.001). Both groups had similar times to discharge (median 7.5 hour [IQR 4.9-17.4] vs 7.5 hour [IQR 5.5-11.0]; p=0.81), but patients with ML were less likely to have same day discharge (67.5% vs 77.0%; p=0.02). Complications (13.6% vs 9.7%; p=0.19), wound infection (1.9% vs 1.9%; p=1.00), post-operative blood transfusion (0.6% vs 0.5%; p=0.57), and re-admission (1.3% vs 1.1%; p=0.69) were similar between ML and morcellation groups. In multivariable analysis, there was no difference in same day discharge between ML and morcellation groups after controlling for age, cancer diagnosis, and operative time (odds ratio=0.94; 95% CI (0.59-1.46); p=0.78). <h3>Conclusions:</h3> Despite increased EBL and operative time, ML for specimen retrieval does not affect postoperative outcomes such as time to discharge, wound infection, complications, need for blood transfusion, or re-admission rates. These results highlight that ML may play an important role when removing large specimens while still enabling patients to have a successful MIS procedure and same day discharge.

Results of active remote cardiac monitoring of oncohematological patients

BACKGROUND: Despite their targeted effects, targeted drug therapies also lead to adverse events, including various cardiac effects. AIM: This study aims to determine the possibility of treating cardiovascular diseases underlying or occurring as a side effect of ibrutinib treatment without blocking targeted therapy for chronic lymphocytic leukemia (CLL). MATERIALS AND METHODS: From 2016 to the present, we have examined and followed 217 patients with CLL who were continuously treated with ibrutinib targeted therapy for five years. The study included patients with CLL, aged 32 to 91 years [median age of 66.0 (32.091.0) years], including 136 men aged 66.0 (32.091.0) years and 81 women aged 65.0 (39.083.0) years. All patients underwent electrocardiography, echocardiography, 24-hour electrocardiographic Holter monitoring, 24-hour blood pressure monitoring, assessment of comorbidities using the Charlson Index, and screening for fragility using the G8 questionnaire. RESULTS: Active cardiac monitoring, including continuous remote monitoring of cardioprotective therapy intake and efficiency, allows oncohematological patients to achieve higher overall survival rates. The long-term monitoring group included a statistically significant number of patients with atrial fibrillation and/or arterial hypertension and patients who receive dual and triple antithrombotic therapy. This group included patients with CLL and more severe cardiac status than other patients, who were regularly observed by a cardiologist. CONCLUSIONS: Widespread introduction of the techniques for continuous remote monitoring of the oncological patients condition into clinical practice will improve the patients quality of life and increase their life expectancy.

Ischemic strokes in oncological patients—treatment and challenges: a literature review

At present, one out of ten patients with ischemic stroke has also an established oncological diagnosis and this frequency is expected to rise with the continuing success and progress in diagnosing cancer and as a direct result from the treatment, which in its turn prolongs the life of those patients. The heightened quality of life is one of the major targets for the team managing oncological patients. The present studies show that the recurring clinical and subclinical strokes worsen the performance status of the patient—as they are the leading cause of disability and death among the oncological patients and the general population. The advancements in the screening, establishing the diagnosis, and treating the oncological condition have led to more and more patients with an increased five-year survival rate. This on the other hand increases the number of patients susceptible to a higher risk of ischemic strokes—both due to the risk factors of the general population and the cancer-specific risk factors related to the tumor itself, its management and treatment. The established direct relation between venous thrombosis and oncological conditions points towards a risk factor for arterial thromboembolism, including ischemic strokes. With the higher volume of gathered information, both from management and follow-up of cancer patients and survivors and from autopsies, the main focus has shifted from venous thromboembolism to the more dramatic arterial events. Even so, the intrinsic mechanisms are undetermined. In addition, the optimal strategies for prevention and active treatment are not well established. This literature review aims at systematic analysis on the prevention and treatment of oncological patients with ischemic strokes with focus on the possible strategies for facing the problem.

Healthcare-Associated Viral Respiratory Infections in a Pediatric Intensive Care Unit and Cardiovascular Intensive Care Unit

Background: Healthcare-associated infections (HAIs) affect patient health and are tracked closely by infection prevention. Patients in a pediatric intensive care unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We sought to determine the types of viral respiratory HAIs (VR-HAIs) acquired in the PICU and the characteristics of those affected. Methods: CHOC Children’s Hospital is a 334-bed tertiary-care center. Charts were reviewed on patients with VR-HAIs from fiscal years (FY) 2005–2020. High-risk VR-HAI (HR-VR-HAI) were influenza A and B, respiratory syncytial virus (RSV), adenovirus, parainfluenza, and human metapneumovirus (hMPV, added in FY 2014). Patients in the PICU, cardiovascular ICU (CVICU), and oncology ICU (OICU) with HR-VR-HAIs were reviewed. Patients were categorized according to underlying pathology, immunosuppression, and isolation prior to HR-VR-HAI. Increased respiratory support was defined as any increase from a patient’s baseline support ±24 hours of viral diagnosis: increase in oxygen flow or transition from nasal cannula to high-flow nasal cannula or ventilator support. Antibiotic escalation, defined as initiation of antibiotic therapy for ≥2 days ±24 hours of viral diagnosis or broadening the spectrum of antimicrobials for ≥2 days ±24 hours of viral diagnosis. Results: During FY 2005–2020, there were 204 VR-HAIs: 143 HR-VR-HAIs (70%), of which 39 (27.2%) occurred in ICUs (Figure 1). Most of the HR-VR-HAIs were RSV, parainfluenza, and hMPV (Figure 2). Of 39 patients, 10 (25.6%) had underlying oncologic conditions, 9 of whom were immunosuppressed. Of 39 patients, 16 (41%) had structural cardiac disease, 4 (10.3%) had pulmonary disease, 5 (12.8%) had neurologic disease, and the remaining 4 (10.3%) had other comorbidities. Of 39 patients, 12 (31%) required an increase in respiratory support and 13 (33%) had escalation of antibiotics. Of 39 HR-VR-HAI patients, 2 died within 2 weeks of acquisition. Conclusions: HR-VR-HAIs are uncommon in ICUs. RSV, parainfluenza, and hMPV are the most common, and 1 of 3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series, there were 2 deaths within 2 weeks of infection.Funding: NoDisclosures: None

Obesity – a closer look to cell mechanisms disfunction

Obesity is a complex, multifactorial condition, a major public health problem with an increasing prevalence worldwide. Obesity is characterized by an excess of adipose tissue, a low degree of chronic inflammation and disorders in the synthesis of biologically active hormones and peptides which intervene in regulating appetite and energy balance, immunity, insulin sensitivity, angiogenesis, blood pressure, lipid metabolism and homeostasis of the body. The visceral adipose tissue accumulation is accompanied by metabolic disorders that have as a substrate subclinical inflammation and signaling by intracellular pathways that lead to irreversible cellular structural and functional changes. The long-term impact of overweight and obesity translates into shortening life expectancy and disability, due to association with severe comorbidities, such as cardiovascular diseases, diabetes, oncological conditions. Therefore, understanding the cellular mechanisms involved in obesity may facilitate the highlighting of new possible therapeutic targets.

Therapeutics for paediatric oncological emergencies.

BackgroundWith advancements in the field of oncology, cancer survival rates have improved dramatically but modern cancer treatments also come with an increasing number of disease and treatment-associated complications. This article provides an updated narrative review on the pathophysiology, clinical presentations and latest management strategies for common paediatric oncological emergencies.MethodsAn extensive PubMed® search of all human studies in the English literature was performed in Clinical Queries for different oncology syndromes and conditions using the following Medical Subject Headings: “tumour lysis syndrome”, “hyperleukocytosis”, “disseminated intravascular coagulation”, “superior mediastinal syndrome”, “superior vena cava syndrome”, “sepsis”, “severe inflammatory response syndrome”, “acute respiratory distress syndrome”, “posterior reversible encephalopathy syndrome” and “reversible posterior leukoencephalopathy syndrome”. Categories were limited to clinical trials and reviews for ages from birth to 18 years.ResultsThe general description, presentation and management of these oncologic emergencies are systematically described. Early recognition along with prompt and proactive treatment can reduce the chances of potential complications and improve the clinical outcomes, thereby improving not only survival rates in oncology patients but also their clinical outcomes and quality of life.ConclusionsOncologic emergencies are associated with significant mortality and morbidity. Healthcare professionals involved with the care of oncology patients must be vigilant of these emergencies.

Highly efficient CD4+ T cell targeting and genetic recombination using engineered CD4+ cell-homing mRNA-LNPs

Nucleoside-modified messenger RNA (mRNA)-lipid nanoparticles (LNPs) are the basis for the first two EUA (Emergency Use Authorization) COVID-19 vaccines. The use of nucleoside-modified mRNA as a pharmacological agent opens immense opportunities for therapeutic, prophylactic and diagnostic molecular interventions. In particular, mRNA-based drugs may specifically modulate immune cells, such as T lymphocytes, for immunotherapy of oncologic, infectious and other conditions. The key challenge, however, is that Tcells are notoriously resistant to transfection by exogenous mRNA. Here, we report that conjugating CD4 antibody to LNPs enables specific targeting and mRNA interventions to CD4+ cells, including Tcells. After systemic injection in mice, CD4-targeted radiolabeled mRNA-LNPs accumulated in spleen, providing ∼30-fold higher signal of reporter mRNA in Tcells isolated from spleen as compared with non-targeted mRNA-LNPs. Intravenous injection of CD4-targeted LNPs loaded with Cre recombinase-encoding mRNA provided specific dose-dependent loxP-mediated genetic recombination, resulting in reporter gene expression in about 60% and 40% of CD4+ Tcells in spleen and lymph nodes, respectively. Tcell phenotyping showed uniform transfection of Tcell subpopulations, with no variability in uptake of CD4-targeted mRNA-LNPs in naive, central memory, and effector cells. The specific and efficient targeting and transfection of mRNA to Tcells established in this study provides a platform technology for immunotherapy of devastating conditions and HIV cure.

Microbiota and cancer (review of literature)

Article presents current data on the contribution of the human microbiota to the development of oncological conditions, microbial impact on cell transformation, influence on chemotherapy outcome. Brief description of the methods used for studying microbiota in carcinogenesis as well as prospects of creating non-invasive diagnostic tools is given.

Generation of Monoclonal Antibodies for Sensitive Detection of Pro-Inflammatory Protein S100A9

The calcium-binding protein S100A9 regulates inflammatory processes and the immune response. It is overexpressed in a variety of inflammatory and oncologic conditions. In this study, we produced a recombinant human S100A9 (hS100A9) antigen with high yield and purity and used it to generate a hybridoma cell culture-based monoclonal anti-hS100A9 antibody. We selected five anti-hS100A9 antibodies from cell supernatants that showed high antigen binding efficiency and identified the nucleotide sequences of three antibodies: two with high effective concentration values and one with the lowest value. The antigen and antibody development procedures described herein are useful for producing large amounts of monoclonal antibodies against hS100A9 and other antigens of interest. The nucleotide sequences of the anti-hS100A9 monoclonal antibody revealed herein will be helpful in the generation of recombinant antibodies or antibody fragments against hS100A9.

Early phase studies of JAK1 selective inhibitors in rheumatoid arthritis.

The first approved Janus kinase (JAK) inhibitors for treatment of RA targeted more than one JAK molecule. Although this brings an advantage of simultaneous blocking of more cytokines involved in RA, it may also carry an increased risk of toxicity. Subsequently, more selective JAK inhibitors were developed with the aim of improving the safety–efficacy profile and to further increase drug maintenance. With this proposal, early phase trials of selective JAK1 inhibitors, namely upadacitinib, filgotinib and itacitinib, were initiated in recent years to identify the efficacy and adverse effects of these agents and to define their potential role in treatment of inflammatory and autoimmune diseases. Early phase (Phase I–II) studies of upadacitinib and filgotinib provided evidence for efficacy and safety of the selective JAK1 inhibitors in refractory populations of RA patients and allowed informed selection of the appropriate dose by balancing the optimal benefit–risk profile for further evaluation in the later successfully performed Phase III trials. Although itacitinib also demonstrated a good efficacy and safety in a Phase II trial in RA patients, it is mainly in development for haematologic and oncologic conditions.

COVID-19 herd immunity by immunisation: are children in the herd?

COVID-19 herd immunity by immunisation: are children in the herd?

461 A review of cutaneous lymphoma outcomes during COVID-19 pandemic at Columbia University

New York-Presbyterian Hospital and Columbia University Irving Medical Center were heavily impacted by the COVID-19 pandemic. Various measures were taken in an effort to ensure patient and staff safety. The management of patients with complex dermatological oncologic conditions, such as cutaneous lymphomas was especially challenging. We retrospectively reviewed the charts of the patients with cutaneous lymphomas who had COVID-19 (n=7) as well as those who did not have COVID-19 (n=26) from March to September 2020.

Immunotherapy and psychosis: It there a risk?

IntroductionOver the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%).Objectives To review the effects of monoclonal antibodies on psychosis.MethodsReview of literature using PubMed database. A total of 16 studies were included.ResultsThe targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy.ConclusionsThe available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.

Psychiatric aspects of the end of life in oncologic patients

IntroductionPatients with life-limiting oncologic conditions should be approached by multidisciplinary teams that contribute to improve their quality of life, including support from mental health dedicated professionals. It is the role of the psychiatrist to understand the relationship between mental health and general health outcomes, specific of this type of patients. Terminally ill and dying patients benefit from psychiatric support, and it seems to have real effects in terms of patient care and medical staff education.ObjectivesTo identify approaches and mental health professionals’ practices regarding end-of-life issues in terminally ill cancer patients.MethodsReview of the most recent literature regarding end-of-life issues in terminally ill cancer patients. The research was carried out through the Cochrane, UptoDate, PubMed, MedLine, LILACS and SciELO databases, using the terms “oncology”, “psychiatry” and “end of life”, until December 2020.ResultsWhile symptoms of anxiety and depression are common in palliative care settings, generally related to feelings of helplessness and fear of death, they should not be assumed to be an inevitable part of it. For terminally ill patients, anxiety and trauma-related disorders can manifest in various ways and it is important to establish personalized treatment approaches, based on a supportive clinical team, and, if necessary, psychotherapy and psychopharmacologic or complementary treatments.ConclusionsIt is extremely important to assess terminally ill patients from the mental health point of view. It is required that psychiatrists take part in clinical care and research on the treatment of these patients with severe medical conditions, in order to increase their quality of life.DisclosureNo significant relationships.