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Brustia R, Bouattour M, Allaire M, Lequoy M, Hollande C, Regnault H, Blaise L, Ganne-Carrié N, Vilgrain V, Larrey E, Lim C, Scatton O, Mouhadi SE, Ozenne V, Paye F, Balladur P, Dohan A, Massault PP, Pol S, Dioguardi Burgio M, Sepulveda A, Cauchy F, Luciani A, Sommacale D, Leroy V, Calderaro J, Roudot-Thoraval F, Nault JC, Amaddeo G. Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area: What's new 12 months later? Ann Hepatol 2023; 28:101141. [PMID: 37468096 DOI: 10.1016/j.aohep.2023.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES The lockdown policy introduced in 2020 to minimize the spread of the COVID-19 pandemic, significantly affected the management and care of patients affected by hepatocellular carcinoma (HCC). The aim of this follow-up study was to determine the 12 months impact of the COVID-19 pandemic on the cohort of patients affected by HCC during the lockdown, within six French academic referral centers in the metropolitan area of Paris. MATERIALS AND METHODS We performed a 12 months follow-up of the cross-sectional study cohort included in 2020 on the management of patients affected by HCC during the first six weeks of the COVID-19 pandemic (exposed), compared to the same period in 2019 (unexposed). Overall survival were compared between the groups. Predictors of mortality were analysed with Cox regression. RESULTS From the initial cohort, 575 patients were included (n = 263 Exposed_COVID, n = 312 Unexposed_COVID). Overall and disease free survival at 12 months were 59.9 ± 3.2% vs. 74.3 ± 2.5% (p<0.001) and 40.2 ± 3.5% vs. 63.5 ± 3.1% (p<0.001) according to the period of exposure (Exposed_COVID vs. Unexposed_COVID, respectively). Adjusted Cox regression revealed that the period of exposure (Exposed_COVID HR: 1.79, 95%CI (1.36, 2.35) p<0.001) and BCLC stage B, C and D (BCLC B HR: 1.82, 95%CI (1.07, 3.08) p = 0.027 - BCLC C HR: 1.96, 95%CI (1.14, 3.38) p = 0.015 - BCLC D HR: 3.21, 95%CI (1.76, 5.85) p<0.001) were predictors of death. CONCLUSIONS Disruption of routine healthcare services because of the pandemic translated to reduced 1 year overall and disease-free survival among patients affected by HCC, in the metropolitan area of Paris, France.
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Affiliation(s)
- Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France.
| | - Mohamed Bouattour
- Département d'Oncologie Hépatique, AP-HP, Hôpital Beaujon, F-92110 Clichy, France
| | - Manon Allaire
- Sorbonne Université, Paris, France; Hepatology and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Marie Lequoy
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Clémence Hollande
- Department of Hepatology, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Hélène Regnault
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France
| | - Lorraine Blaise
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France - INSERM U1149 "centre de recherche sur l'inflammation", CRI, Paris France
| | - Edouard Larrey
- Sorbonne Université, Paris, France; Hepatology and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Chetana Lim
- Digestive and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Olivier Scatton
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France; Digestive and Liver transplantation department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, F-75013 Paris, France
| | - Sanaa El Mouhadi
- Department of Radiology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Violaine Ozenne
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - François Paye
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Pierre Balladur
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, F-75012 Paris, France
| | - Anthony Dohan
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Pierre-Philippe Massault
- Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Stanislas Pol
- Department of Hepatology, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France - INSERM U1149 "centre de recherche sur l'inflammation", CRI, Paris France
| | - Ailton Sepulveda
- Digestive and Liver transplantation department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Francois Cauchy
- Digestive and Liver transplantation department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Alain Luciani
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Department of Radiology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; Paris Est Créteil University, UPEC, Créteil, France
| | - Daniele Sommacale
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Paris Est Créteil University, UPEC, Créteil, France
| | - Vincent Leroy
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; Paris Est Créteil University, UPEC, Créteil, France
| | - Julien Calderaro
- Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France; Inserm, U955, Team 18, Créteil, France; European Reference Network (ERN) RARE-LIVER, France
| | | | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Giuliana Amaddeo
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Créteil, France - Assistance Publique-Hôpitaux de Paris, France; Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France; Paris Est Créteil University, UPEC, Créteil, France.
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Mehta N, Parikh ND, Kelley RK, Hameed B, Singal AG. Surveillance and Monitoring of Hepatocellular Carcinoma During the COVID-19 Pandemic. Clin Gastroenterol Hepatol 2021; 19:1520-1530. [PMID: 32652308 PMCID: PMC7342037 DOI: 10.1016/j.cgh.2020.06.072] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/27/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic is expected to have a long-lasting impact on the approach to care for patients at risk for and with hepatocellular carcinoma (HCC) due to the risks from potential exposure and resource reallocation. The goal of this document is to provide recommendations on HCC surveillance and monitoring, including strategies to limit unnecessary exposure while continuing to provide high-quality care for patients. Publications and guidelines pertaining to the management of HCC during COVID-19 were reviewed for recommendations related to surveillance and monitoring practices, and any available guidance was referenced to support the authors' recommendations when applicable. Existing HCC risk stratification models should be utilized to prioritize imaging resources to those patients at highest risk of incident HCC and recurrence following therapy though surveillance can likely continue as before in settings where COVID-19 prevalence is low and adequate protections are in place. Waitlisted patients who will benefit from urgent LT should be prioritized for surveillance whereas it would be reasonable to extend surveillance interval by a short period in HCC patients with lower risk tumor features and those more than 2 years since their last treatment. For patients eligible for systemic therapy, the treatment regimen should be dictated by the risk of COVID-19 associated with route of administration, monitoring and treatment of adverse events, within the context of relative treatment efficacy.
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Affiliation(s)
- Neil Mehta
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California.
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - R. Katie Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Bilal Hameed
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Amit G. Singal
- Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
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Sweed D, Abdelsameea E, Khalifa EA, Abdallah H, Moaz H, Moaz I, Abdelsattar S, Abdel-Rahman N, Mosbeh A, Elmahdy HA, Sweed E. SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore. EGYPTIAN LIVER JOURNAL 2021; 11:64. [PMID: 34777871 PMCID: PMC8325538 DOI: 10.1186/s43066-021-00123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pandemic of COVID19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China as an unexplained pneumonia transmitted by respiratory droplets. Gastrointestinal (GI) and liver injury associated with SARS-CoV-2 infection were reported as an early or sole disease manifestation, mainly outside China. The exact mechanism and incidence of GI and liver involvement are not well elucidated. MAIN BODY We conducted a PubMed search for all articles written in the English language about SARS-CoV-2 affecting the GI and liver. Following data extraction, 590 articles were selected. In addition to respiratory droplets, SARS-CoV-2 may reach the GI system through the fecal-oral route, saliva, and swallowing of nasopharyngeal fluids, while breastmilk and blood transmission were not implicated. Moreover, GI infection may act as a septic focus for viral persistence and transmission to the liver, appendix, and brain. In addition to the direct viral cytopathic effect, the mechanism of injury is multifactorial and is related to genetic and demographic variations. The most frequently reported GI symptoms are diarrhea, nausea, vomiting, abdominal pain, and bleeding. However, liver infection is generally discovered during laboratory testing or a post-mortem. Radiological imaging is the gold standard in diagnosing COVID-19 patients and contributes to understanding the mechanism of extra-thoracic involvement. Medications should be prescribed with caution, especially in chronic GI and liver patients. CONCLUSION GI manifestations are common in COVID-19 patients. Special care should be paid for high-risk patients, older males, and those with background liver disease.
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Affiliation(s)
- Dina Sweed
- Pathology Department, National Liver Institute, Menofia University, Shibin El Kom, 32511 Egypt
| | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menofia University, Shibin El Kom, Egypt
| | - Esraa A. Khalifa
- Radiology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
| | - Heba Abdallah
- Clinical Pathology Department, National Liver Institute, Menofia University, Shibin El Kom, Egypt
| | - Heba Moaz
- Microbiology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
| | - Inas Moaz
- Epidemiology and Preventive Medicine Department, Menofia University, Shibin El Kom, Egypt
| | - Shimaa Abdelsattar
- Clinical Biochemistry, and Molecular Diagnostics Department, National Liver Institute, Menofia University, Shibin El Kom, Egypt
| | | | - Asmaa Mosbeh
- Pathology Department, National Liver Institute, Menofia University, Shibin El Kom, 32511 Egypt
| | - Hussein A. Elmahdy
- Biochemistry Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Eman Sweed
- Clinical Pharmacology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
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Fancellu A, Sanna V, Scognamillo F, Feo CF, Vidili G, Nigri G, Porcu A. Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations. World J Clin Cases 2021; 9:3517-3530. [PMID: 34046452 PMCID: PMC8130078 DOI: 10.12998/wjcc.v9.i15.3517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Valeria Sanna
- Unit of Medical Oncology, AOU Sassari, Sassari 07100, Italy
| | - Fabrizio Scognamillo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 1 - Patologia Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Unit of Internal Medicine, University of Sassari, Sassari 07100, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome 00189, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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Santonicola A, Zingone F, Camera S, Siniscalchi M, Ciacci C. Telemedicine in the COVID-19 era for Liver Transplant Recipients: an Italian lockdown area experience. Clin Res Hepatol Gastroenterol 2021; 45:101508. [PMID: 32907791 PMCID: PMC7402272 DOI: 10.1016/j.clinre.2020.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on COVID-19 in Liver Transplant (LT) recipients are scanty, but one can hypothesize that they are more susceptible to infection due to chronic immunosuppression. Telemedicine could be an alternative to the routine clinical care in this difficult period. We aimed to investigate in a cohort of LT recipients the access to remote consultation and the attitude towards Telemedicine using an internet-based survey. MATERIAL AND METHODS We invited LT recipients from the Liver Transplant Follow-up Center of the University Hospital of Salerno to access remote consultation. A subgroup of them also participated in a self-administered, internet-based survey evaluating demographics; LT data and immunosuppressive therapy; comorbidities; attitudes towards COVID-19 infection; their perceptions of the need for health care, and their approach to telemedicine. RESULTS Seventy-four/one hundred and fifty-three (48.3%) LT recipients were unable to access remote consultation. They showed a significantly higher mean age and a higher percentage of low school degree compared to those who accessed it (p=0.03 and p=0.001, respectively). Among the remaining LT recipients, 50/79 (63.3%) responded to the survey; mean time from liver transplantation was 12±7 years; 94% of the sample reported at least one comorbidity; 44% of LT recipients declared to be "very much/much" worried because of COVID-19 infection, and 64% considered themselves more vulnerable than the general population. Forty percent of responders refused the routine follow-up visit, and 62% were very interested in using Telemedicine. CONCLUSION LT recipients were anxious because of COVID-19 infection and considered themselves more vulnerable than the general population, refusing the routine clinical visit. For continuing services during the COVID-19 era, new strategies are needed and telemedicine shows promise.
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Affiliation(s)
- Antonella Santonicola
- Liver Transplant Clinic, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, 35100 Padua, Italy
| | - Silvia Camera
- Liver Transplant Clinic, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Monica Siniscalchi
- Liver Transplant Clinic, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Carolina Ciacci
- Liver Transplant Clinic, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy,Corresponding author at: Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Via S. Leonardo 184131, Salerno, Italy
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Gatellier L, Shankar A, Dewi LKM, Hussain QM, Dendup Wangdi T, Sukumaran DB, Sari NK, Tavakkoli Shiraji S, Biglari M, Tahmasebi M, Iwata S, Suzuki T, Myung SK, Chun JY, Han JS, Lau FN, Yusak S, Bayarsaikhan L, Mu KT, Pradhananga KK, Yusuf A, Lin CH, Chiang RCJ, Sangrajran S, Nguyen QT, Huong GN, Soe AN, Sharma DN, Sengar M, Pramesh CS, Matsuda T, Jarrahi AM, Hwang W. The Impact of COVID-19 on Cancer Care in the Post Pandemic World: Five Major Lessons Learnt from Challenges and Countermeasures of Major Asian Cancer Centres. Asian Pac J Cancer Prev 2021; 22:681-690. [PMID: 33773529 PMCID: PMC8286686 DOI: 10.31557/apjcp.2021.22.3.681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: The COVID-19 pandemic has dramatically affected healthcare services around Asia. The Asian National Cancer Centres Alliance and the Asia-Pacific Organisation for Cancer Prevention collaborated to assess the mid- and long- term impact of COVID-19 to cancer care in Asia. Methods: The two entities organised a combined symposium and post-meeting interactions among representatives of major cancer centres from seventeen Asian countries to outlining major challenges and countermeasures. Results: Participating stakeholders distilled five big questions. 1) “Will there be an explosion of late-stage cancers after the pandemic?” To address and recover from perceived delayed prevention, screening, treatment and care challenges, collaboration of key stakeholders in the region and alignment in cancer care management, policy intervention and cancer registry initiatives would be of essential value. 2) “Operations and Finance” The pandemic has resulted in significant material and financial casualties. Flagged acute challenges (shortages of supplies, imposition of lockdown) as well as longer-standing reduction of financial revenue, manpower, international collaboration, and training should also be addressed. 3) “Will telemedicine and technological innovations revolutionize cancer care?” Deploying and implementing telemedicine such as teleconsultation and virtual tumour boards were considered invaluable. These innovations could become a new regular practice, leading to expansion of tele-collaboration through collaboration of institutions in the region. 4) “Will virtual conferences continue after the pandemic?” Virtual conferences during the pandemic have opened new doors for knowledge sharing, especially for representatives of low- and middle-income countries in the region, while saving time and costs of travel. 5) “How do we prepare for the next pandemic or international emergency?” Roadmaps for action to improve access to appropriate patient care and research were identified and scrutinised. Conclusion: Through addressing these five big questions, focused collaboration among members and with international organisations such as City Cancer Challenge will allow enhanced preparedness for future international emergencies.
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Affiliation(s)
| | - Abhishek Shankar
- Lady Hardinge Medical College & Associated Hospitals, Delhi, India
| | - Luh K Mela Dewi
- Dharmais Hospital - National Cancer Center, Jakarta, Indonesia
| | | | | | | | | | - Sahar Tavakkoli Shiraji
- Hematology, Oncology and Bone Marrow transplantation Research Center, Shariati Hospital, Tehran University of Medical Science,Tehran, Iran
| | - Mohammad Biglari
- Hematology, Oncology and Bone Marrow transplantation Research Center, Shariati Hospital, Tehran University of Medical Science,Tehran, Iran
| | - Mamak Tahmasebi
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Seung-Kwon Myung
- National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - June Young Chun
- National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - Jong Soo Han
- National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - Fen Nee Lau
- National Cancer Institute, Putrajaya, Malaysia
| | | | | | - Khin Thin Mu
- Myanmar Yangon General Hospital, Yangon, Myanmar
| | | | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Ching-Hung Lin
- National Taiwan University Cancer Center Hospital, Taipei City, Taiwan
| | - Ruru Chun-Ju Chiang
- Taiwan Cancer Registry, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | - D N Sharma
- Dr BR Ambedkar Institute Rotary Cancer Hospital & National Cancer Institute, All India Institute of Medical Sciences, Delhi, India
| | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Amaddeo G, Brustia R, Allaire M, Lequoy M, Hollande C, Regnault H, Blaise L, Ganne-Carrié N, Séror O, Larrey E, Lim C, Scatton O, El Mouhadi S, Ozenne V, Paye F, Balladur P, Dohan A, Massault PP, Pol S, Dioguardi Burgio M, Vilgrain V, Sepulveda A, Cauchy F, Luciani A, Sommacale D, Leroy V, Roudot-Thoraval F, Bouattour M, Nault JC, Paris Liver Cancer Group ‡. Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area. JHEP Rep 2021; 3:100199. [PMID: 33163949 PMCID: PMC7604130 DOI: 10.1016/j.jhepr.2020.100199] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/29/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Patients affected by hepatocellular carcinoma (HCC) represent a vulnerable population during the COVID-19 pandemic and may suffer from altered allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of patients with HCC within 6 referral centres in the metropolitan area of Paris, France. METHODS We performed a multicentre, retrospective, cross-sectional study on the management of patients with HCC during the first 6 weeks of the COVID-19 pandemic (exposed group), compared with the same period in 2019 (unexposed group). We included all patients discussed in multidisciplinary tumour board (MTB) meetings and/or patients undergoing a radiological or surgical programmed procedure during the study period, with curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treat. RESULTS After screening, n = 670 patients were included (n = 293 exposed to COVID, n = 377 unexposed to COVID). Fewer patients with HCC presented to the MTB in 2020 (p = 0.034) and fewer had a first diagnosis of HCC (n = 104 exposed to COVID, n = 143 unexposed to COVID, p = 0.083). Treatment strategy was modified in 13.1% of patients, with no differences between the 2 periods. Nevertheless, 21.5% vs. 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared with 2019 (p <0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) patients were hospitalised and 4 (19.1%) patients died. CONCLUSIONS In a metropolitan area highly impacted by the COVID-19 pandemic, we observed fewer patients with HCC, and similar rates of treatment modification, but with a significantly longer treatment delay in 2020 vs. 2019. LAY SUMMARY During the coronavirus disease 2019 (COVID-19) pandemic era, fewer patients with hepatocellular carcinoma (HCC) presented to the multidisciplinary tumour board, especially with a first diagnosis of HCC. Patients with HCC had a treatment delay that was longer in the COVID-19 period than in 2019.
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Key Words
- 2019-nCoV
- BCLC, Barcelona Clinic Liver Cancer
- COVID-19
- Cirrhosis
- EASL, European Association for the Study of Liver
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- ICU, intensive care unit
- IQR, inter-quartile range
- IR, interventional radiology
- ITT, intention to treat
- LR, liver resection
- LT, liver transplantation
- MELD, model for end-stage liver disease
- MTB, multidisciplinary tumour board
- Management
- NASH, non-alcoholic steatohepatitis
- OR, odds ratio
- SIRT, selective internal radiation therapy
- TACE, transarterial chemoembolisation
- aOR, adjusted OR
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Affiliation(s)
- Giuliana Amaddeo
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Manon Allaire
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Marie Lequoy
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - Hélène Regnault
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Lorraine Blaise
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Nathalie Ganne-Carrié
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Olivier Séror
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Edouard Larrey
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Chetana Lim
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Scatton
- Sorbonne Université, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Sanaa El Mouhadi
- Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Violaine Ozenne
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - François Paye
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Pierre Balladur
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Anthony Dohan
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Stanislas Pol
- Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
| | - Ailton Sepulveda
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Francois Cauchy
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Alain Luciani
- Paris Est Créteil University, UPEC, Créteil, France
- Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Daniele Sommacale
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Vincent Leroy
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - Mohamed Bouattour
- Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
| | - Jean-Charles Nault
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Paris Liver Cancer Group‡
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Paris Est Créteil University, UPEC, Créteil, France
- INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Paris, France
- Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
- Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
- Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
- Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
- Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
- Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
- Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
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Cadranel JF, Reboux N, Nousbaum JB. COVID-19: an emergent cause of liver injury? Eur J Gastroenterol Hepatol 2021; 33:1-3. [PMID: 32639418 PMCID: PMC7690325 DOI: 10.1097/meg.0000000000001824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | - Noémi Reboux
- Service d’Hépato-Gastroentérologie, CHU La Cavale Blanche, Brest, France
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9
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Gundavda MK, Gundavda KK. Cancer or COVID-19? A Review of Guidelines for Safe Cancer Care in the Wake of the Pandemic. ACTA ACUST UNITED AC 2020; 2:2691-2701. [PMID: 33251481 PMCID: PMC7679239 DOI: 10.1007/s42399-020-00632-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Andheri West, Mumbai, Maharashtra 400053 India
| | - Kaival K Gundavda
- Department of Surgical Oncology, Tata Memorial hospital, 93, Ground floor, Main Building, Mumbai, Maharashrta 400012 India
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10
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Abstract
The COVID-19 pandemic has imposed a critical challenge to the current oncology care and practices including late diagnoses, delayed anti-cancer treatment, and static clinical trials. With the increasing risk of cancer patients acquiring infection during receiving the essential care, the debate ensues on how to balance the risk factors and benefits out of the oncologic emergencies in cancer patients. In this review article, we have focused on the current global re-organization of the integrity and effectiveness of the treatment modalities depending on the patient and cancer-specific urgencies while minimizing exposure to the infection. In this review, we addressed how the worldwide oncology community is united to share therapy schemes and the best possible guidelines to help cancer patients, and to strategize and execute therapy/trial protocols. This review provides collective knowledge on the current re-structuring of the general framework that prioritizes cancer care with the available exploitation of the reduced resources and most importantly the unparalleled levels of companionship as a large health care community towards the need to offer the best possible care to the patients.
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11
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Georgiev T, Angelov AK. Complexities of diagnosis and management of COVID-19 in autoimmune diseases: Potential benefits and detriments of immunosuppression. World J Clin Cases 2020; 8:3669-3678. [PMID: 32953843 PMCID: PMC7479565 DOI: 10.12998/wjcc.v8.i17.3669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
Recent advances in our understanding of coronavirus disease 2019 (COVID-19) and the associated acute respiratory distress syndrome might approximate the cytokine release syndrome of severe immune-mediated disease. Importantly, this presumption provides the rationale for utilization of therapy, until recently reserved mostly for autoimmune diseases (ADs), in the management of COVID-19 hyperinflammation condition and has led to an extensive discussion for the potential benefits and detriments of immunosuppression. Our paper intends to examine the available recommendations, complexities in diagnosis and management when dealing with patients with ADs amidst the COVID-19 crisis. Mimicking a flare of an underlying AD, overlapping pathological lung patterns, probability of higher rates of false-positive antibody test, and lack of concrete data are only a part of the detrimental and specific characteristics of COVID-19 outbreak among the population with ADs. The administration of pharmaceutical therapy should not undermine the physical and psychological status of the patient with the maximum utilization of telemedicine. Researchers and clinicians should be vigilant for upcoming research for insight and perspective to fine-tune the clinical guidelines and practice and to weigh the potential benefits and detrimental effects of the applied immunomodulating therapy.
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Affiliation(s)
- Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital "St. Marina", First Department of Internal Medicine, Medical University - Varna, Varna 9010, Bulgaria
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