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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.

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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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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