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.
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.”
Medical Officer of Health gives monkeypox update – North Bay News – BayToday.ca
The local medical officer of health for the North Bay Parry Sound District Health Unit is urging calm when it comes to the monkeypox outbreak that has reached Canada.
The multi-country outbreak of monkeypox — a rare disease that comes from the same family of viruses that causes smallpox — has been active since early May.
As of Wednesday, a total of 219 confirmed cases have been reported worldwide. Most of the cases have been detected in young men, who self-identify as men who have sex with men (MSM). Of those, there are 118 confirmed cases reported from 12 EU/EEA Member States.
According to Dr. Michael Head, a senior research fellow in global health at the University of Southampton (UK), “Monkeypox, as the name suggests, was first found in laboratory monkeys in the late 1950s. However, scientists aren’t sure if monkeys are the main animal reservoirs (carriers of the virus), so the name may be a bit of a misnomer. The latest thinking is that the main reservoir is probably smaller animals, such as rodents.”
The European Centre for Disease Prevention and Control (ECDC) observes this is the first time chains of monkeypox transmission have been reported in Europe without known epidemiological links to West or Central Africa.
There are 16 confirmed cases in Canada, according to the Public Health Agency of Canada, all in Quebec.
Although the “risk posed by monkeypox is low, nearly everyone in Canada is susceptible because routine vaccination against smallpox ended decades ago,” PHAC officials said late last week in this CP report stating Canada is considering using a reserve of smallpox vaccine for monkeypox cases.
“Let’s look at the risk and put it into perspective,” says Dr. Jim Chirico following Wednesday’s Board of Health meeting. “The overall risk to the general public is very, very low.”
“Monkeypox (MPX) does not spread easily between people. Human-to-human transmission occurs through close contact with infectious material from skin lesions of an infected person, through respiratory droplets in prolonged face-to-face contact, and through fomites (such as contaminated clothes, towels or furniture). The predominance, in the current outbreak, of diagnosed human MPX cases is among men having sex with men (MSM), and the nature of the presenting lesions in some cases, suggests transmission occurred during sexual intercourse,” according to an ECDC risk assessment.
The virus is spread through close contact between people, especially in the same household, including the sexual route, advises ECDC. Based on its epidemiological assessment, “the likelihood of MPX spreading in persons having multiple sexual partners in the EU/EEA is considered high.”
Being aware of the signs and symptoms is the most important part, says Chirico “but most cases are very mild and besides treatment for the symptoms, nothing else is usually required and most people do not end up in the hospital. It’s limited. In two to four weeks, it’s over.”
The monkeypox virus may cause severe disease in certain population groups, such as young children, pregnant women, and immunosuppressed persons.
“Although most cases in current outbreaks have presented with mild disease symptoms,” notes the ECDC risk assessment, “the likelihood of cases with severe morbidity cannot be accurately estimated yet. The overall risk is assessed as moderate for persons having multiple sexual partners (including some groups of MSM) and low for the broader population.”
Chirico advises local residents to “be aware of the signs and symptoms of monkeypox. Initially, they are similar to the flu, where you might have a headache, fever, chills, muscle aches, maybe back pain, and fatigue. You can also experience sweating and the other important thing to note are any lumps and bumps, like lymph nodes that are increasing.”
About one to three days following the onset of symptoms, a rash may appear — and it may appear on the face and go to the rest of the body. In about 75 per cent of the cases, it will be on the hands and feet, he says.
A personal risk assessment of monkeypox infection is also important, says Dr. Chirico. “Sexual contacts, possible exposure to an individual diagnosed with monkeypox or an individual that is symptomatic and awaiting lab confirmation.
“If you have signs and symptoms of monkeypox, immediately isolate and arrange to be tested by your primary health care provider. And, remain in isolation until the result of your test is known. If you do test positive for monkeypox, you do need to isolate until the lesions resolve, meaning the scabs have fallen off and new skin is present.
“If you are a contact of an individual with monkeypox, you can self-monitor for symptoms for 21 days and seek medical care or testing if the symptoms present but you don’t need to quarantine if you don’t have any symptoms as a contact.”
Montreal sauna suspected origin of Canada’s monkeypox outbreak: doctors – Global News
The country’s first two cases were reported by Quebec public health officials on May 19.
Dr. Robert Pilarski, a general physician in Montreal, who treated one of those patients last week, said the individual likely got the virus from a sauna he recently visited.
“He actually got it from G.I. Joe. So this is the suspected epicentre of the epidemic,” Pilarski told Global News.
Another doctor, who did not wish to be identified, also said the source of Montreal’s monkeypox outbreak was Sauna G.I. Joe.
Government officials have so far stayed clear of confirming the origin of monkeypox in Canada due to concerns of privacy and stigmatization.
“As it was the case with COVID-19, we never confirm publicly outbreaks for both privacy and identification matters,” Jean Nicolas Aubé, a spokesperson for Montreal public health, told Global News in an emailed response.
“Rest assured that we always intervene directly with businesses or settings where an outbreak occurs or where our investigation could lead us,” Aube added.
Quebec confirms 25 cases of monkeypox, plans to administer vaccine
Despite multiple attempts and inquiries from Global News about health regulations and tracing measures, there was no response from Sauna G.I. Joe by the time of publication.
Recent cases of monkeypox around the world have researchers scrambling to find out how the virus is spreading in countries that typically don’t see it.
Monkeypox, a rare zoonotic infectious disease, is usually found in certain parts of Africa, where it is endemic.
What started out as a small cluster of cases in Quebec is now being called a “serious outbreak” of the virus by provincial health officials.
As of Thursday, 25 cases have been confirmed in the province and about 20 to 30 suspected cases are under investigation.
The majority of confirmed cases in the province are tied to men aged between 20 and 30 years, who have had sexual relations with other men. There has been one case in a person under 18.
Monkeypox is not considered a sexually-transmitted infection, but the virus can survive on surfaces such as bedding and is transmitted through prolonged close contact.
“It’s not sexual activity as such that transmits it. It’s skin-to-skin contact that transmits it as far as we know at this moment,” said Dr. Michael Libman, a tropical disease expert and professor of medicine and infectious disease at McGill University.
Scientists trying to identify origins of Monkeypox cases detected in Canada
Stigmatization and transparency
Cases of monkeypox started emerging in Europe earlier this month.
Montreal public health said it had alerted physicians about a week before the first cases were confirmed. It also contacted “local actors” and communicated advice on hand hygiene and environmental cleaning procedures, Aubé said.
According to social media posts, Sauna G.I. Joe hosted a sex party on May 19, the same day Canada confirmed its first cases of monkeypox.
During a press conference on Thursday, Quebec public health officials said they do not think it’s necessary to single out locations over fears of “stigmatization,” adding that there are now measures in place.
“The enemy is the virus, not the people affected,” said Dr. Luc Boileau, Quebec’s interim public health.
However, experts stress that there should be greater transparency and omitting key public health information can be problematic.
Monkeypox is not a sexually-transmitted infection, WHO says
David Brennan, research chair in gay and bisexual men’s health at the Ontario HIV Treatment Network (OHTN), believes not disclosing information can have a negative impact on the community.
Hiding information could be interpreted as “men having sex with men is bad,” said Brennan.
There needs to be a culture shift and harm-reduction approach as has been the case in the past with sexually-transmitted infections, such as HIV/AIDS, added Nolan Hill, gay men’s health specialist at the Center for Sexuality in Calgary, Alta.
“I think it really does speak to this broader culture where we’re uncomfortable with the idea of sex and we’re uncomfortable talking about sex,” he said.
What is monkeypox and how is it transmitted?
Outside of Quebec, only one other case of monkeypox has been confirmed in Toronto.
On Saturday, Toronto Public Health (TPH) identified two locations connected to possible cases of monkeypox: Axis Club and Woody’s bar.
Kerry Bowman, a professor of bioethics and global health at the University of Toronto, said these details matter, especially when it comes to higher risk settings.
“I would argue it is important to identify where it is coming from because if you don’t then people are not in a position to protect themselves,” he said.
However, disclosing that information comes with the “added responsibility” of not feeding into any prejudice, Bowman added.
Federal public health officials are working to finalize and release guidance on case identification, contact tracing, isolation as well as infection prevention and control.
The Public Health Agency of Canada says this updated guidance will be released in the next few days.
Deputy chief public health officer Dr. Howard Njoo said Thursday mass vaccinations are not yet needed, but people can avoid infection by maintaining physical distance, masking and hand hygiene.
Monkeypox: 26 confirmed cases in Quebec, Ontario, officials recommend physical distancing
© 2022 Global News, a division of Corus Entertainment Inc.
Quebec health officials confirm 25 monkeypox cases now in province – Global News
Quebec public health officials are reporting a total of 25 confirmed cases of monkeypox in the province as of Thursday.
Dr. Luc Boileau, interim public health director in the province, described it as a “serious outbreak” of the virus. Officials are investigating several more suspected cases.
“We had about 20 to 30 suspected cases under investigation so far,” Boileau said.
The province will also begin administering the Imvamune vaccine to close contacts of confirmed or suspected cases of monkeypox as soon as Friday. A single dose will be provided within four days of exposure to the virus.
Quebec’s Health Ministry said in a statement that a second dose of the vaccine could be administered, but only if the risk of exposure is “still present 28 days later” and “only following a decision by public health authorities.”
Boileau said the majority of confirmed cases in the province are tied mostly to men who have had sexual relations with other men. There has been one case in a person under 18.
Last week, Quebec recorded the first cases of the virus in the country. The first suspected cases were reported on May 12 in Montreal.
Monkeypox is a rare disease that comes from the same family of viruses that causes smallpox, which the World Health Organization declared eradicated around the globe in 1980.
The virus spreads through prolonged closed contact. It can cause fever, headache, muscle aches, exhaustion, swollen lymph nodes and lesions.
— with files from Global News’ Dan Spector and the Canadian Press
© 2022 Global News, a division of Corus Entertainment Inc.
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