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Delayed cancer care amid COVID-19 may raise death rates – CIDRAP

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A pair of studies today estimated the COVID-19 pandemic’s potential effects on cancer deaths, with one predicting rising US cancer deaths over the next decade owing to screening deficits, and the other suggesting that cancer surgery delays in Ontario could lead to poorer survival rates.

To accommodate surges of critically ill COVID-19 patients, many healthcare facilities around the world canceled or delayed appointments for other indications, including cancer. Before COVID-19 vaccines were available, patients with nonemergent conditions also were advised to stay home rather than risk infection in crowded hospitals or clinics.

The unintended consequences of these public health measures are still being measured.

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Median 18% drop in colorectal cancer screening

In the first study, published in Cancer, a team led by Northwestern University researchers conducted a national quality-improvement (QI) study on the return to cancer screening among 748 accredited US cancer programs from April through June 2021. They used prepandemic and pandemic monthly screening test volumes (MTVs) to identified screening gaps.

Most facilities reported gaps in monthly screenings for colorectal cancer (104 of 129 [80.6%]), cervical cancer (20/29 [69.0%]), breast cancer (241/436 [55.3%]), and lung cancer (98/220 [44.6%]).

The median relative changes in MTVs were -17.7% for colorectal cancer, -6.8% for cervical cancer, -1.6% for breast cancer, and 1.2% for lung cancer. No geographic differences were seen.

These findings prompted participating cancer programs to start 814 QI projects to break down barriers to cancer screening, including screening resources. While the effects of these projects on screening rates through 2021 are still being evaluated, the estimated numbers of potential MTVs, should all facilities reach their target goals, could be 57,141 for breast cancer, 6,079 for colorectal cancer, 4,280 for cervical cancer, and 1,744 for lung cancer.

“Cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020,” the researchers wrote.

In a press release from Wiley, publisher of the journal, corresponding author Heidi Nelson, MD, of the American College of Surgeons, said that the team hopes that the QI programs will prevent many cancer deaths.

“From the perspective of what this means about our programs, we now know that we can turn to our accredited programs in times of crisis to help address large-scale cancer problems,” she said. “Knowing how enthusiastic these accredited programs are for working collaboratively on national level problems, we expect to release one or two quality improvement projects each year going forward.”

10-year survival could fall up to 0.9%

To assess the effect of COVID-19–related cancer surgery delays on survival, University of Toronto researchers built a microsimulation model using real-world population data on cancer care in Ontario from 2019 and 2020.

The study, published in the Canadian Medical Association Journal (CMAJ), estimated cancer surgery wait times over the first 6 months of the pandemic by simulating a slowdown in operating room capacity (60% operating room resources in month 1, 70% in month 2, and 85% in months 3 to 6), compared with simulated prepandemic conditions with 100% resources.

The model population consisted of 22,799 patients awaiting cancer surgery before the pandemic and 20,177 new referrals. Average wait time to surgery before the pandemic was 25 days, compared with 32 days after. As a result, 0.01 to 0.07 life-years were lost per patient across cancer types, translating to 843 life-years lost among cancer patients.

The largest percentages of life-years lost were among patients with nonprostate genitourinary (0.07 life-years lost), gastrointestinal (0.05), and head and neck cancers (0.05), all of which carry a high risk of death. Ten-year survival fell by 0.3% to 0.9% across all studied cancer types in the pandemic model compared with the prepandemic era, with the greatest change in patients with hepatobiliary cancers (26.0% before vs 25.1% after).

In a scenario of a 60% reduction in surgical resources for cancer patients in the first 6 months of the pandemic, incremental increases in wait time of 10 to 21 days over prepandemic wait times translated to 0.1 to 0.11 life-years lost per patient and reductions in 10-year survival of 0.3 to 1.6 percentage points across cancer types. The changes indicate the loss of 1,539 life-years.

In a different scenario in which surgical resources were reduced to 60% for the first 2 months of the pandemic and raised to 75% for the next 4 months, wait times were shorter than under the first scenario (incremental increase, 8 to 19 days), leading to the loss of fewer (1,306) life-years.

The study authors called for future studies to characterize the additional impact of pandemic-related diagnostic delays and changes in cancer stage on cancer survival.

“Pandemic-related slowdowns of cancer surgeries were projected to result in decreased long-term survival for many patients with cancer,” they wrote. “Measures to preserve surgical resources and health care capacity for affected patients are critical to mitigate unintended consequences.”

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The Key Role of Trustworthy Babysitters in Balancing Work and Family Life

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Babysitters

Are you a busy parent in constant pursuit of the elusive work-life balance? We know firsthand how overwhelming and challenging it can be to juggle professional commitments while still having quality time with your children.

That’s why we’re here to discuss an essential ingredient that unlocks the secret to harmony: trustworthy babysitters.

What Characteristics Parents Should Look for When Choosing a Babysitter?

Parents should look for a few key characteristics when choosing a babysitter. A good babysitter should be patient, responsible, and reliable. They should also be comfortable with children and have prior experience caring for them.

Besides, the babysitter must be able to communicate effectively and follow directions well. The babysitter should be someone the parents can trust to care for their children in their absence.

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Strategies for Parents to Establish Reasonable Anticipations

As a parent, finding babysitters you can trust to care for your children is vital. However, it is also important to establish reasonable expectations for your babysitters.

Some tips for establishing reasonable expectations for babysitters include:

  1. Set clear expectations: Sit down with your babysitter to discuss bedtime routines, dietary preferences, and any necessary medications.
  2. Allow flexibility: While clarity is vital, also provide room for your babysitter to use their judgment and feel comfortable in their role.
  3. Trust their expertise: Once expectations are set, trust your babysitter’s judgment as a professional caregiver to avoid undermining their authority and creating discomfort in their role.

Determining a Fair Payment Plan

Determine your babysitting budget, factoring in your income and family size, while researching local rates. Account for the babysitter’s experience and qualifications, giving preference to those recommended by trusted sources.

Engage in open negotiations with your chosen babysitter. This aims to find a mutually agreeable arrangement that accommodates both your budget and their needs.

Tips on Finding Trustworthy and Compassionate Caregivers

When seeking a caregiver for your child, to ensure you find the right fit:

  • Seek recommendations from trusted sources such as friends, family, and neighbours who may have suggestions for caregivers in your area.
  • Conduct online research to review feedback and check references to gauge candidates’ qualifications and experience.
  • Request references and contact details from the caregivers’ previous employers or families they have worked with.
  • Trust your instincts and ensure you feel at ease with the caregiver, ensuring they are someone you can entrust with your child’s well-being.

Conclusion

Being able to trust your babysitter means you can have peace of mind knowing your child is safe and cared for.

Spending some time researching online reviews or asking friends and family for recommendations will help you find the perfect fit so you can feel more at ease while juggling work commitments in today’s hectic world.

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Facility-wide COVID-19 outbreak at Bethammi Nursing Home

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THUNDER BAY — St. Joseph’s Care Group and the Thunder Bay District Health Unit have declared a facility-wide COVID-19 outbreak at Bethammi Nursing Home, part of the St. Joseph’s Heritage complex on Carrie Street near Red River Road.

The respiratory outbreak at the 112-bed facility was declared effective Sept. 15 but only announced publicly on Monday.

No details were provided with regard to the number of people affected to date.

Restrictions are now in place for admissions, transfers, discharges, social activities and visitation until further notice.

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Alberta COVID hospitalizations up 73% since July: health minister

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Three weeks after the start of the school year, Alberta’s health minister provided an update on the spread of airborne viruses in the province.

Adriana LaGrange also said more information about flu and next-generation COVID-19 vaccines will soon be released.

“Now that we will be spending more time indoors, we need to make doubly sure we are following proper hygiene protocols like handwashing and staying home when sick,” LaGrange said. “It also means respecting those who choose to wear a mask.”

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Global News previously reported that influenza vaccines will be available on Oct. 16 with the new Moderna vaccine formulated to target the XBB.1.5 variant likely to be available at around the same time. On Sept. 12, Health Canada approved the use of the Moderna vaccine.

“More information on immunizations against respiratory viruses including influenza and COVID-19 will be available shortly,” the health minister said.

LaGrange said there have been 28 cases of influenza and five lab-confirmed cases of respiratory syncytial virus (RSV) since Aug. 28.

“This is consistent activity for this time of the year,” the health minister said in a statement.

The end of August or the beginning of September has typically marked the beginning of flu season for provincial health authorities.

LaGrange also provided an update on the ongoing COVID-19 pandemic in the province.

From Aug. 28 to Sept. 8, there were a total 92 new hospitalizations and three ICU admissions, bringing the total to 417 in hospital and seven in ICU, a 73 per cent increase of COVID hospitalizations from the last reported info.

On July 24 – the last update to the province’s COVID data dashboard – there were only 242 in hospital.

“Sadly, five Albertans died during that period due to COVID-19,” LaGrange said.

LaGrange said the reporting dashboard is being refreshed to include RSV, influenza and COVID-19 data, work that was originally expected to be completed on Aug. 30. The latest data on the province’s influenza statistics dashboard is dated July 22.

“This work is currently underway and will be available in the coming weeks,” LaGrange said.

She said data for the dates between July 24 and Aug. 27 will be available when the new dashboard goes online.

Amid more hospitals continent-wide reinstating masking requirements in the face of increased hospitalizations, the health minister made no mention of any such moves for Alberta hospitals. Acute care COVID-19 outbreaks in Alberta jumped from Sept. 5 to 12, with 146 per cent more healthcare workers and 55 per cent more patients testing positive for COVID.

LaGrange stressed the “collective responsibility” to prevent the spread of airborne viruses like COVID and influenza.

“As a mother and grandmother, I understand the anxiety that comes with sending your children back to school. I want to reassure you that Alberta’s government has the health and well-being of all young Albertans top of mind,” the health minister said.

–with files from Meghan Cobb, Global News

 

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