疫情期间肿瘤患者应当如何就医

新冠肺炎来势汹汹,不仅给全社会造成了巨大的损失,也对整个医疗体系提出了严峻的考验。在疫情期间如何就医,尤其是肿瘤患者如何就医,是当前面临的巨大难题。肿瘤患者受疾病或抗肿瘤治疗的影响,机体的免疫功能低下,成为了病毒的易感人群。特殊时期如何既保证肿瘤的诊治,又降低患者的感染风险,我们给不同治疗时期的肿瘤患者在疫情期间的就医提出一些建议。     

肿瘤专科医院放疗患者新冠疫情期间的防控管理CSCD

新冠肺炎(COVID-19)疫情对肿瘤患者的常规诊疗造成影响。由于肿瘤患者免疫力低,为病毒易感人群,且预后差,特别是放疗患者需每天往返于病房与放疗机房之间,增加了病毒的感染机会,应是疫情防治的重点对象。我院作为肿瘤专科医院,在疫情暴发期间,做到了防控与收治两不误。在医院感控办指导下,成立院级及科级防控小组,采取一系列防控管理措施,如标准化培训及物理空间区域的划分、规范收治及放疗流程、可跟踪式闭环管理及人文关怀等。我院处在中国疫情最为严重的武汉,放疗中心在接诊患者的2月内,做到了患者及工作人员零感染,有效地防范了新冠肺炎,确保了放疗患者的安全及正常治疗。     

新型冠状病毒肺炎疫区肿瘤患者的防控策略

目的:探讨疫区中心肿瘤患者在疫情期间有效预防新型冠状病毒肺炎的措施。方法:回顾性分析2020年1月23日至2月22日期间，在武汉大学中南医院腹部肿瘤放化疗科的13名患者、家属以及医护人员的感染情况，从医护人员感染防控、留院患者和家属感染防控以及出院肿瘤患者的居家防控三个角度制定和实施防控措施。结果:有1例发热患者诊断结果为疑似，2名医生确诊新型冠状病毒肺炎，其他患者、家属、医护无感染。结论:在疫情期间做好科室医护筛查与防护、患者个人防护、病区环境清洁消毒、发热患者及时隔离等措施可以防止肿瘤患者院内交叉感染，降低新型冠状病毒肺炎的感染率。     

COVID-19疫情下妇科恶性肿瘤的临床管理策略

新冠肺炎疫情期间,由于医疗资源的再分配,妇科恶性肿瘤患者的常规医疗受到极大影响。恶性肿瘤患者因为接受抗肿瘤治疗后免疫力低,合并感染后症状重,成为疫情的易感人群和预防的重点对象。随着疫情的好转,妇科恶性肿瘤患者的治疗需求尤为强烈。在复杂的新冠肺炎疫情下,接受化疗、免疫治疗及需手术治疗的妇科恶性肿瘤患者如出现发热及呼吸道症状,更需要仔细地进行鉴别诊断,评估新冠肺炎感染的风险。因此对于这一类患者,在新冠肺炎疫情期间的抗肿瘤治疗,需要进行全面的管理。本文从对手术患者及化疗、免疫治疗患者的门诊管理、院内患者及陪同人员、医护工作人员的管理及对患者的院外管理三个方面全面阐述了COVID-19疫情下,妇科恶性肿瘤的临床管理策略,力求在有效防范新冠肺炎的同时,最大程度地治疗肿瘤。     

肿瘤患者新冠疫苗接种:临床研究进展与初步临床推荐

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19,简称新冠肺炎)疫情对全球公众健康产生了严重影响.广泛接种新型冠状病毒疫苗(简称新冠疫苗)成为终止新冠疫情的最可能有效的手段之一.肿瘤患者在新冠肺炎疫情中感染风险大、严重事件发生率高、死亡率高,应是疫情防治的重点对象.目前肿瘤患者新冠疫...     

肿瘤患者感染新冠病毒的风险更高?

新型冠状病毒肆虐,给大家的生命、健康带来威胁。肿瘤患者是否较普通人更容易被感染?肿瘤患者该如何应对?请中国抗癌协会肿瘤病因学专委会主任委员邓大君教授为大家答疑解惑。从发病机制来说,肿瘤患者是否较普通人群更容易感染新冠肺炎?新冠肺炎的发病机制是人体接触病毒之后,对病毒做出免疫反应。     

新型冠状病毒肺炎疫情期间乳腺癌患者随访流程优化

正2019年12月以来,以湖北省武汉市为中心,全国各省市、自治区、新疆生产建设兵团以及境外陆续出现了多例新型冠状病毒肺炎(简称新冠肺炎)患者。该病毒潜伏期长、传染性强。截止2020年2月26日24时,全国累计确诊患者78 497例,累计死亡患者2 744例,疑似患者及累计追踪到密切接触者652 174例~([1])。疫情之下,陆军军医大学第一附属医院乳腺甲状腺外科全体医护人员积极响应号召,参照国家、军队以及重庆市相关政策法规及规章制度及时制定并发布了《新型冠状病毒肺炎疫情期间乳腺疾病患者诊治流程管理》~([2])、《新型冠状病毒肺炎疫情下乳腺癌日间化疗病房运行管理实践》~([3])等一系列乳腺疾病管理流程。工作人员严格执行这些管理流程,基本保障了需来院手术、化疗和靶向治疗等患者的需求,实现了在科学防控的基础上最大限度保证肿瘤患者诊治的目的~([4])。     

疫情期间肿瘤患者应如何防范感染

新型冠状病毒具有较强的传染性和致病性,目前尚缺乏有效的治疗手段。这使得新冠肺炎的预防成为疫情防控的重中之重。肿瘤患者由于疾病本身或治疗的原因,往往自身免疫功能低下,一旦感染后果可能更为严重。这已被2020年2月14日Lancet Oncology(柳叶刀·肿瘤)在线发布的一项研究所证实。     

新冠肺炎流行期间肿瘤患者PICC的维护

新冠肺炎流行期间，肿瘤患者定期PICC维护面临着困难，延迟维护可能面临着感染、血栓形成、导管堵塞、拔出困难等并发症，本文从肿瘤患者PICC并发症的影响因素、预防措施、疫情期间患者和医护双方的准备来阐述，未来需加强互联网在PICC置管患者健康教育中的应用，推广医院-社区协同模式，解决患者就近维护的难题。     

新冠肺炎疫情期间对软组织肿瘤患者的建议

软组织肿瘤是一类起源于脂肪、肌肉、血管、神经、肌腱、韧带等结缔组织的肿瘤。其中,恶性的软组织肿瘤被为软组织肉瘤。软组织肉瘤在临床相对少见,仅约占成年人恶性肿瘤的1%,但其种类繁多,不同病理类型的治疗与预后也不尽相同。那么,在新冠肺炎疫情期间,软组织肿瘤的患者需要注意哪些方面呢?以下为相关的病友提供几点建议。     

新型冠状病毒肺炎疫情期间结直肠癌患者的个人管理策略

新型冠状病毒肺炎（COVID-19）疫情爆发以来，其传染性强、传播范围广、人群普遍易感的特点使得疫情进展迅猛。结直肠癌在我国发病率及病死率均较高，且患者往往免疫力低下，为COVID-19的易感人群，而当前全国正处于COVID-19防控工作的紧张阶段，给结直肠癌患者的诊疗带来了巨大的挑战。本文就疫情期间结直肠癌患者的日常防护、就医诊疗、营养管理、心理支持及合理随访等展开探讨，为结直肠癌患者的安全管理提供参考。     

新型冠状病毒肺炎疫情下肿瘤患者焦虑现状及影响因素的分析研究

目的:分析新型冠状病毒肺炎疫情下肿瘤患者焦虑现状及其影响因素。方法:对60例肿瘤患者进行问卷调查研究,内容包括人口学特征、疫情关注情况、疾病诊治情况及焦虑自评量表（SAS）;统计分析影响患者焦虑量表评分的因素。结果:60例肿瘤患者SAS评分平均为（52.71±8.23）分,多因素分析结果显示城镇居民、疫情造成严重生活影响以及肿瘤诊治延迟或停止是造成肿瘤患者焦虑的主要因素（P<0.05）。结论:新型冠状病毒肺炎疫情影响下,肿瘤患者焦虑情绪明显,尤其针对疫情严重影响生活、肿瘤治疗延迟或停止及居住在城市的患者可考虑针对性给予干预,以减轻患者的焦虑心理。     

新冠肺炎疫情期间乳腺癌患者诊疗情况及心理状态调查

目的:了解新型冠状病毒肺炎（以下简称新冠肺炎）流行期间乳腺癌患者诊疗情况及心理状态,为今后出现类似突发公共卫生事件时有的放矢,为乳腺癌患者诊疗指导及心理干预提供依据。方法:采用问卷调查法,对全国26省市新冠肺炎疫情前正在接受抗肿瘤治疗的乳腺癌患者疫情期间的诊疗情况及心理状态进行线上问卷调查。采用SPSS 22.0对调查结果进行分析。结果:共收集626份问卷,在被调查的乳腺癌患者中,16.80%的患者西医治疗延迟或中断,其中静脉化疗和靶向治疗受限人数最多;30.85%的患者中医治疗延迟或中断;55.68%的患者复查随访延迟;59.81%的患者西医治疗延迟或中断长达4周及以上。受疫情影响,28.64%的患者出现焦虑和(或)抑郁,达到需要进行心理专科干预者占被调查总人数的12.32%。且在延迟诊疗人群中焦虑和(或)抑郁比例明显高于非延迟治疗人群(33.50% vs 26.70%,P<0.05)。结论:大部分乳腺癌患者诊疗(包括复查随访和治疗)在疫情期间延迟或中断。此外,乳腺癌患者在疫情期间焦虑抑郁比例明显增高,且与治疗延迟相关。因此,在疫情期间及时为患者提供便捷的诊疗指导及心理疏导有助于帮助患者从容应对疫情,减少心理压力,控制乳腺癌发生发展。     

The Short-Term Impact Of COVID-19 Pandemic on Cervical Cancer Screening: A Systematic Review and Meta-Analysis

Objective: A systematic review and meta-analysis were carried out to assess the pooled proportion of women screened for cervical cancer before and during the COVID-19 pandemic. Methods: After ruling out registered or ongoing systematic reviews in the PROSPERO database regarding the impact of the COVID-19 pandemic in cervical cancer screening, the protocol of our systematic review and meta-analysis was registered in PROSPERO (CRD42021279305). The electronic databases were searched for articles published in English between January 2020 and October 2021and the study was designed based on PRISMA guidelines updated in 2020. Meta-analysis was accomplished in STATA version 13.0 (College Station, Texas 77,845 USA). The pooled proportion of women who had undergone cervical cancer screening was reported with 95% CI. In order to quantify the heterogeneity, Chi2 statistic (Q statistic) and I2 index were used. Results: The meta-analysis included seven studies from Slovenia, Italy, Ontario (Canada), Scotland, Belgium, and the USA, comprising 403,986 women and 199,165 women who were screened for cervical cancer before the COVID-19 pandemic in 2019 and during the pandemic in 2020, respectively. The pooled proportion of women screened for cervical cancer in 2019 was 9.79% (95% CI 6.00%-13.59%, 95% prediction interval 0.42%-23.81%). During the pandemic, the pooled proportion of screened women declined to 4.24% (95% CI 2.77%-5.71%, 95% prediction interval 0.9%-17.49%). Conclusion: There was a substantial drop in the cervical cancer screening rate due to lockdowns and travel restrictions to curb the COVID-19 pandemic. Scaling up cervical cancer screening strategies is essential to prevent the long-term impact of cervical cancer burden.     

新型冠状病毒肺炎疫情期间乳腺癌患者诊疗建议

目的乳腺癌患者受疾病或抗肿瘤治疗的影响,机体处于免疫低下状态,是2019新型冠状病毒肺炎(corona virus disease 2019,COVID-19)的易感人群之一。本研究为乳腺癌患者在COVID-19疫情期间提出诊疗建议。方法应用维普、知网、PubMed检索系统,以"新型冠状病毒肺炎、乳腺癌、指南、延迟、时机"或"COVID-19、breast cancer、guidelines、delaying、timeliness"等为检索词,检索2014-01-2020-01相关文献,共检索到英文文献19篇,中文文献12篇。纳入标准:(1)报道乳腺癌手术、化疗、放疗或内分泌治疗延迟治疗情况;(2)有关COVID-19诊治流程管理;(3)乳腺癌诊治指南。根据标准共纳入20篇文献。结果针对目前国内的疫情,对于常规复查患者,在病情稳定情况下可暂缓复查。对于晚期患者维持治疗阶段,应根据患者症状、肿瘤负荷,适当简化检查,重点检查靶病灶或症状明显的器官。对于内分泌治疗、靶向维持治疗、进行骨相关治疗、化疗及放疗的患者,应根据疾病分期和治疗阶段,维持或调整治疗方案。对于乳腺癌手术患者,可短时间暂缓手术。如确定要实施手术,应尽可能缩小手术范围,缩短手术时间。结论在COVID-19疫情的特殊时期,乳腺癌患者的治疗应遵循指南,合理诊治,科学防护。     

Differences in mortality of cancer patients with COVID-19 in a Brazilian cancer center

IntroductionTo analyze COVID-19 mortality in cancer patients and associated factors such as age, sex, type of insurance, situation at COVID-19 diagnosis, and cancer histology during the pandemic at a cancer center in Brazil.MethodsCross-sectional study carried out from April 02, 2020 to August 31, 2020 at A.C. Camargo Cancer Center (ACCCC), in São Paulo, Brazil. Cases were extracted from the Hospital Cancer Registry. COVID-19 lethality rates by histology were calculated; multiple logistic regression was used to identify factors associated with COVID-19 mortality. The log-rank test was applied to compare the survival curves for each variable.ResultsOf the 411 patients analyzed, 51 (12.4%) died due to COVID-19. Death occurred at an average age of 63 years. The fatality rate was higher for lung (0.333) and hematological (0.213) cancers and was associated with age over 60 years. The greatest chances of death from COVID-19 were in cases of lung (odds ratio, OR, 4.05, 95% confidence interval, CI 1.33–12.34) and hematological (OR 2.17, 95% CI 0.96–4.90) cancers, and in patients currently undergoing cancer treatment (OR 2.77, 95% CI 1.25–6.13). There were no statistical differences in survival by sex, age group, type of insurance, situation at the diagnosis of COVID-19, and histology of cancer for COVID-19.ConclusionsMortality due to COVID-19 in cancer patients is heterogeneous. These findings reinforce the need for individualized strategies for the management of different types of cancer that reduce the risk of death from COVID-19.     

新型冠状病毒病(COVID-19)疫情期间恶性肿瘤高剂量率近距离治疗推荐

目前国内新型冠状病毒病疫情总体呈现散发状态,防范疫情任务仍然艰巨。近距离治疗(BT)在肿瘤患者治疗中起着重要的作用,在部分恶性肿瘤放疗过程中,BT不能被替代也不可过度延迟。而对于疫情期间BT推荐或指导的相关报道较少。本文总结国内外可检索到的较少几篇关于疫情期间BT的推荐,结合吉林大学中日联谊医院放射治疗科在前期疫情期间的工作经验,希望可以给同行们提供疫情期间恶性肿瘤高剂量率BT的参考。     

Recommendations on high-dose-rate rachytherapy for malignant tumors during COVID-19 epidemic

InChina, COVID-19 epidemic is currently showing a sporadic state, and the task of epidemic prevention is still arduous. Brachytherapy (BT) plays a critical role in the treatment of cancer. For some cancer receiving radiotherapy, use of BT can not be replaced or excessively delayed. Nevertheless, the recommendations or guidelines regarding the application of BT during COVID-19 epidemic have been rarely reported. In this article, a few recommendations on the application of BT during COVID-19 epidemic were retrieved and the work experience of Department of Radiation Oncology, China-Japan Union Hospital of Jilin University in the early epidemic period was summarized, aiming to provide relevant reference for the use of high-dose-rate BT for malignant tumor patients during COVID-19 epidemic.     

Continuity of care for patients with de novo metastatic cancer during the COVID-19 pandemic: A population-based observational study

During the COVID-19 pandemic recommendations were made to adapt cancer care. This population-based study aimed to investigate possible differences between the treatment of patients with metastatic cancer before and during the pandemic by comparing the initial treatments in five COVID-19 periods (weeks 1–12 2020: pre-COVID-19, weeks 12–20 2020: 1st peak, weeks 21–41 2020: recovery, weeks 42–53 2020: 2nd peak, weeks 1–20 2021: prolonged 2nd peak) with reference data from 2017 to 2019. The proportion of patients receiving different treatment modalities (chemotherapy, hormonal therapy, immunotherapy or targeted therapy, radiotherapy primary tumor, resection primary tumor, resection metastases) within 6 weeks of diagnosis and the time between diagnosis and first treatment were compared by period. In total, 74,208 patients were included. Overall, patients were more likely to receive treatments in the COVID-19 periods than in previous years. This mainly holds for hormone therapy, immunotherapy or targeted therapy and resection of metastases. Lower odds were observed for resection of the primary tumor during the recovery period (OR 0.87; 95% CI 0.77–0.99) and for radiotherapy on the primary tumor during the prolonged 2nd peak (OR 0.84; 95% CI 0.72–0.98). The time from diagnosis to the start of first treatment was shorter, mainly during the 1st peak (average 5 days, p < .001). These findings show that during the first 1.5 years of the COVID-19 pandemic, there were only minor changes in the initial treatment of metastatic cancer. Remarkably, time from diagnosis to first treatment was shorter. Overall, the results suggest continuity of care for patients with metastatic cancer during the pandemic.     

Evaluating the Impact of the COVID-19 Pandemic on New Cancer Diagnoses and Oncology Care in Manitoba

Individuals with cancer are vulnerable to infection with SARS-CoV-2, the virus causing COVID-19. Physical distancing, the reallocation of health care resources, and the implementation of procedures to reduce the spread of COVID-19 may also have serious consequences for people with cancer. We evaluated the impact of COVID-19 on new cancer diagnoses and oncology care in Manitoba, Canada using an interrupted time series design and data from the Manitoba Cancer Registry and CancerCare Manitoba’s (CCMB) electronic medical record. In April 2020, there was a 23% decrease in new cancer diagnoses, a 21% decrease in pathology reports, and a 43% reduction in surgical resections. There was no difference in new cancer diagnoses by August 2020, surgery by July 2020, and pathology reports by September 2020. From April 2020 to June 2021, there was a 13% decrease in radiotherapy (RT) fractions, an 18% decrease in UCC visits, and a 52% decrease in in-person visits. There was no change in intravenous chemotherapy visits per month, first RT visits, or overall patient visits. The impact of COVID-19 on shifts in the stage at diagnosis and survival will be assessed in future analyses.