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Cancer surgery delays caused by COVID-19 could lead to shorter life spans: study – Global News

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Cancer surgery delays brought on by the COVID-19 pandemic could affect long-term survival for many patients, a new Canadian study shows.

Among the challenges faced by Canada’s health-care system more than two years into the pandemic is the backlog of delayed surgeries and procedures that could take years to clear.

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The new Canadian Medical Association Journal (CMAJ) study adds to the growing body of evidence examining the unintended consequences of the pandemic on patients with cancer.

“Although de-escalation of cancer surgeries during the pandemic may be required to protect vulnerable populations and create health-care capacity, these slowdowns are associated with a risk of unintended harm,” the study, published March 21 in the CMAJ, says.

Using real world data on cancer care from 2019 to 2020, the research examined the impacts of delays on those awaiting surgery before and during the first six months of the pandemic, with a focus on the province of Ontario.

The simulated model population comprised 22,799 patients waiting for cancer surgery before the pandemic and 20,177 patients during. The mean wait time for surgery before COVID-19 was 25 days, which was bumped up to 32 days during the pandemic.

The study looked at those receiving non-emergency surgery, including those with breast, gastrointestinal, genital and urinary, gynecological, head and neck, liver and gallbladder, lung and prostate cancers, and found that during the first half a year of the pandemic, a total of 843 years of life of cancer patients across Ontario could be lost as a result of delays.

“Although our model was a simplification of the diverse disease trajectories,” Dr. Kelvin Chan, the senior author of this study and a medical oncologist at Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, said that “the notable differences in survival by disease site” draws attention to the “need for measures of surgical prioritization during pandemic-related slowdowns.”

Read more:

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At the beginning of the pandemic, Ontario, like other provinces, asked its hospitals to ramp down elective surgeries so the province could prepare to curb the spread of the COVID-19 virus.

During the rapid spread of the Omicron variant, the province again put non-urgent surgeries on hold before resuming them at the end of Jan. 2022.

A report by the Ontario Medical Association last month found the backlog in Ontario alone was more than one million surgeries. Before Ontario’s second surgery shutdown, the association estimated it would take over two years to clean the backlog.


Click to play video: 'Terminal cancer patient speaks out against COVID-19 restrictions'



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Terminal cancer patient speaks out against COVID-19 restrictions


Terminal cancer patient speaks out against COVID-19 restrictions – Feb 8, 2022

The new research estimated that 4,639 patients were on the waitlist for surgery on the first day of the pandemic in Ontario. This included 158 patients with liver and gall bladder cancers and 1,619 patients with genital and urinary cancers.

The study also estimated that 140 new patients would be added to the surgery wait list every single day.

“The health-care response to the COVID-19 pandemic in Ontario was driven by an intention to protect vulnerable populations of patients and reserve adequate health care resources to manage a potential surge of patients with COVID-19,” the study said. “We have shown the unintended consequences of this policy intervention in Ontario.”

“We showed variation in loss of life-years across cancer disease sites.”

With a hypothetical 60 per cent reduction in operating room resources for cancer surgery in the first six months of the pandemic, wait times increased up to 21 days, compared to pre-pandemic, the study found. This translates to an overall total of 1539 years taken off the lives of cancer patients across the province of Ontario.

Cancers with a higher risk of progression, like liver and gall bladder and head and neck cancers, were among the largest variation in life-years lost per patient.

READ MORE: Half million less surgeries performed since pandemic began

Another study from the beginning of the pandemic, in part completed by Western University professor Janet Martin, projected that 28.4 million surgeries worldwide could be cancelled of postponed in 2020 alone.

Each additional week of cancellation could result in a further 2.4 million cancellations, the research said.

Over half a million fewer surgeries were performed across Canada during the first 16-months of the pandemic, compared to previous years, a Canadian Institute for Health Information report from the end of last year suggests.

About 560,000 fewer surgeries were performed between March 2020 and June 2021 compared to the previous 16-month period through 2019, according to health data compiled and analyzed by CIHI for the report.

Ontario had a 76 per cent decline in surgeries in April 2020 compared to a year before — the sharpest drop of any province or territory in that hard-hit month.

Manitoba’s delay grew to over 161,000 diagnostic and surgical procedures as of mid-February of this year, according to Doctors Manitoba, a group representing the province’s doctors.

In Quebec, hospitals across the province had to reduce surgeries by about 50 per cent at the height of the Omicron wave. Dr. Francois Marquis, the chief of intensive care at Montreal’s Maisonneuve-Rosemont hospital, said Friday it will take months for the hospital to bring surgical waiting lists to their already daunting pre-pandemic levels.

“The hospital is not working full speed,” he said. “There are not enough surgeries, there are not enough patients being admitted. You still have rooms that are closed because we don’t have enough nurses and (respiratory therapists).”

Marquis says catching up is a challenge, given the number of nurses that have retired, left the field or transferred. But by working efficiently to streamline procedures, he’s happy to say that the hospital hasn’t cancelled a single surgery recently.

Read more:

Director of Ontario COVID-19 Science Advisory Table stepping down from role

Last week, the Canadian Medical Association (CMA) and some 40 organizations representing health workers called for urgent government action to address issues facing the ailing system.

“While governments and Canadians are hoping to move past the pandemic, an exhausted, depleted health workforce is struggling to provide timely, necessary care to patients and make progress through a significant backlog of tests, surgeries and regular care,” CMA president Katharine Smart said in a statement following an emergency meeting.

“Careful management of health care resources is critical during times of resource constraint to mitigate unintended consequences,” the study echoed.

— With files from the Canadian Press

© 2022 Global News, a division of Corus Entertainment Inc.

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GLP-1 Agonists Protected Kidneys in T2D With Advanced DKD – Medscape

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Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • In patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes but significantly linked with preservation of kidney function and improved survival in a propensity-score matched, retrospective analysis of observational data from more than 2000 people with type 2 diabetes in Taiwan.

Why This Matters

  • Cardiovascular disease is a leading cause of mortality in people with type 2 diabetes and among those with chronic kidney disease.

  • GLP-1 agonists reduce all-cause mortality and cardiovascular death in people with type 2 diabetes, but their role in patients with advanced DKD is controversial.

  • Research on the effect of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD is limited. Trials that have assessed GLP-1 agonists in people with type 2 diabetes have generally excluded those with advanced DKD and completely excluded those with end-stage kidney disease (eGFR < 30 mL/min/1.73m2).

  • Treatment with GLP-1 agonists has been associated with a significant reduction in composite cardiovascular outcomes in people with type 2 diabetes and relatively fair kidney function (eGFR > 30 mL/min/1.73m2), but among people with type 2 diabetes and lower levels of kidney function, research has shown neutral composite cardiovascular outcomes levels. However, limitations of previous studies include being mainly based on subgroup analysis or including a limited sample of patients.

Study Design

  • Retrospective analysis of observational data from nearly 9000 people in Taiwan with type 2 diabetes and an eGFR < 30 mL/min/1.73m2 who received a first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor in 2012-2021 and had the data necessary for this analysis in their records.

  • The data came from the largest multi-institutional electronic medical record database in Taiwan, which includes two medical centers and five general hospitals and information on more than 11 million patients, from 2001 to 2019.

  • Researchers used propensity scoring to match 602 people treated with a GLP-1 agonist with 1479 people treated with a DPP-4 inhibitor.

Key Results

  • During a mean follow-up of 2.1 years, the rate of the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) did not significantly differ between the GLP-1 agonist and DPP-4 inhibitor groups, with incidence rates of 13.0% and 13.8%, respectively, and a nonsignificant hazard ratio of 0.88. Rates of each of the three components of the composite endpoint also did not significantly differ between the two groups.

  • Progression to end-stage kidney disease with dialysis was significantly lower in those treated with a GLP-1 agonist compared with a DPP-4 inhibitor, with incidence rates of 23.4% and 27.5%, respectively, and a significant hazard ratio of 0.72.

  • The incidence of a greater than 50% drop in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared to 35.9% with a DPP-4 inhibitor, with a significant hazard ratio of 0.74.

  • Median time until patients needed new-onset dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, which was a significant difference.

  • The rate of all-cause death was 18.4% with GLP-1 agonist treatment compared with 25.1% with DPP-4 inhibitor treatment, a hazard ratio of 0.71 that was significant.  

Limitations

  • Because the study was a retrospective analysis of observational data it cannot prove causality.

  • The study could be subject to residual confounding despite propensity-score matching.

  • The data came from health records that could have included coding errors.

  • Treatment compliance was unknown.

Disclosures

This is a summary of a preprint research study, “The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease,” by researchers in Taiwan on Research Square and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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Research by UBC professor lays groundwork for life-saving breast cancer treatment – UBC Faculty of Medicine

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A drug originally designed to prevent osteoporosis is now expected to save and improve the lives of millions of people with breast cancer, thanks in part to decades of foundational research by Dr. Josef Penninger, a professor in UBC’s Faculty of Medicine and director of the Life Sciences Institute.

The achievement highlights how UBC scientists are developing effective new treatments — and unlocking the full potential of existing drugs – through research into the fundamental biological principles behind disease. By advancing scientific discoveries from the lab to the clinic, UBC researchers are bringing life-changing treatments to patients everywhere.

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The drug, called Denosumab, was recently shown in a long-term Phase 3 clinical trial to improve survival among postmenopausal women with hormone receptor-positive early breast cancer receiving aromatase inhibitor treatment. Moreover, the drug markedly improved patients’ quality of life by reducing broken bones by 50 per cent, a common side effect of breast cancer treatment. The results of the trial were recently reported in The New England Journal of Medicine.

Denosumab is a monoclonal antibody developed by American biopharmaceutical company Amgen to prevent bone loss. In the early 2000s, research by Dr. Penninger and his team revealed the therapeutic potential of Denosumab, as well as the drug’s surprising connections with breast cancer.

“More than two decades ago we started the experimental groundwork that revealed Donosumab’s potential as a treatment for breast cancer patients,” says Dr. Penninger. “These results are incredibly exciting and will help improve the lives of millions of patients. I am very proud of all the people in my lab over the years who did that work and helped pave the way for this achievement.”

Discovering the link between osteoporosis and breast cancer

Denosumab works by binding to and inhibiting the activity of a protein called RANKL, which plays a key role in bone-resorbing cells called osteoclasts. By blocking RANKL, denosumab reduces the activity of osteoclasts and slows down bone resorption, helping to increase bone density and preventing osteoporosis.

Dr. Josef Penninger

Dr. Josef Penninger

Dr. Penninger and his team began to draw the connection between osteoporosis and HR-positive breast cancer when they generated the first RANKL “knock-out” mice in the late 1990s.

A knockout mouse is a laboratory mouse that has been genetically engineered to have certain genes deactivated, or “knocked-out”. Dr. Penninger’s team engineered mice that lacked the genes necessary to produce the RANKL protein in an effort to study the protein’s essential function in bone metabolism.

However, to the researchers’ surprise, they discovered that the RANKL-deficient mice failed to develop a lactating mammary gland in pregnancy – a process that depends on sex hormones.

“This proved an evolutionary link: showing how bone loss is regulated by sex hormones, and how pregnant mammals activate RANKL to form breast tissue for lactation among other functions,” says Dr. Penninger.

Based on this initial finding, Dr. Penninger’s team went on to show that RANKL played a key role in progestin-driven breast cancer, as well as breast cancer driven by BRCA1 mutations.

“Further researcher revealed how RANKL controls the stem cells in the breast that respond to sex hormones and thereby drives growth of the breast tissue at every menstruation cycle and in particular in pregnancy and lactation,” adds Dr. Penninger.

In the case of breast cancer, RANKL spurs mammary epithelial cells to divide, and helps to maintain the stem cells that give rise to breast tumours.

A dual benefit drug

One in eight Canadian women will be diagnosed with breast cancer in their lifetime according to the Canadian Breast Cancer Network. An estimated 70 to 80 per cent of these breast cancers are hormone receptor-positive (HR-positive), making it the most prevalent breast cancer subtype.

The current standard treatment for HR-positive breast cancer involves surgery and radiation, followed by treatment with aromatase inhibitors for 5 to 7 years. While aromatase inhibitors diminish sex hormones that drive new cancer growth, they can have serious adverse effects on bone health, including increased risk of osteoporosis and fractures.

The now-published clinical trial, led by the Austrian Breast and Colorectal Cancer Study Group, was conducted to see if Denosumab could help in two ways: by reducing these negative effects on bone health, while also improving breast cancer survival outcomes.

“These results are incredibly exciting and will help improve the lives of millions of patients.”
Dr. Josef Penninger

The results reveal that 6 mg of Denosumab every six months — the recommended treatment level for osteoporosis — improved disease-free survival, bone metastasis-free survival, and overall survival among participants. It also effectively reduced bone fractures over the long term.

“Blocking RANKL in breast cancer patients reduces broken bones by 50 per cent, massively improving their quality of life, and even at a very low treatment dose,” says Dr. Penninger. “We now know that RANKL drives breast cancer cell growth, is the critical mechanism behind bone loss, and has also an effect on anti-cancer immunity and immunological rewiring in pregnancy. These clinical results in patients show how blocking RANKL could save the lives of 50,000 women among one million women with the diagnosis of breast cancer.”

Based on the data, the researchers behind the trials are recommending that Denosumab be considered for routine clinical use in postmenopausal breast cancer patients receiving aromatase inhibitor therapy.

These trials were largely based on the foundational research published by the Penninger laboratory, including Kong et al. Nature 1999, Fata et al. Cell 2000, Jones Nature 2006, Schramek et al. Nature 2010, Sigl et al. Cell Research 2016, and Paolino et al. Nature 2021.

Dr. Penninger is now part of a large international prevention trial evaluating Denosumab in young women who carry BRCA1 mutations.

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Respiratory illness peaked in December at Chatham Kent Health Alliance: Suni – Chatham-Kent This Week

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Chatham-Kent Health Alliance officials are reporting a drop in patients visiting the emergency departments with respiratory illnesses between December and January, but admissions from the emergency rooms to the hospitals remain high.

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Caen Suni, the hospital group’s vice president of clinical programs and operations, said patients with illnesses like influenza, COVID-19 and respiratory syncytial virus dropped 50 per cent in January compared to December among children and by one-third among adults.

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“The community is I think essentially working its way through seasonal illness at this point,” he said during a media teleconference Monday.

December also showed a 25 per cent increase over December 2021 for pediatric admissions and of those, 77 per cent were for respiratory illnesses, Suni said.

“That’s impactful and I think that’s what we’ve seen across the health sector in our entire region at this point,” he said.

Suni said the number of people seeking treatment at the emergency departments – which includes patients not admitted – is not “historically high,” but admissions to the hospitals increased in December by three per cent over the previous month.

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This translates to an extra two to three extra patients a day who require a bed. The health alliance also experienced almost 2.5 per cent more admissions in December than any month in the previous year.

However, December also had the lowest daily average of visits to the emergency departments of any month during the Health Alliance’s current fiscal year.

This means a higher proportion of patients require admission to the hospital and patients presenting at the emergency departments are more ill, Suni said.

Since December, the trends are now “pointing towards a decrease,” Suni said, “which we’re thankful for, as the community bounces back from seasonal illness.”

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