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Surgical delays due to COVID-19 could lead to shorter life spans for cancer patients: study – CTV News Toronto

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Longer wait times due to the slowdowns of cancer surgeries during the COVID-19 pandemic in Ontario will likely lead to decreased long-term survival for many patients with cancer, a new study has found.

As the province quickly pulls back pandemic restrictions and the health-care system steams ahead, a research paper published in the Canadian Medical Association Journal on Monday revealed the impact of the Ontario government’s decision to reduce the number of cancer surgeries, along with other elective surgeries, performed in the province during the first COVID-19 wave.

“This research paper used real world data, combined with a simulated model, to demonstrate that delays in surgery in our health-care system in Ontario are likely going to lead to changes in survival for cancer patients in the future,” said Dr. Tony Eskander, a surgical oncologist at Sunnybrook Health Sciences Centre and a lead author of the report.

The province’s decision to reduce the number of elective surgeries was made in anticipation of a potential surge of patients with COVID-19. The study states that while necessary at the time, the strategy resulted in a backlog of cancer surgeries, and some patients faced longer wait times for surgical treatment.

The study focused on patients receiving non-emergent cancer surgery in Ontario. It included patients with breast, gastrointestinal, genitourinary, gynecological, head and neck, hepatobiliary, lung and prostate cancers.

The study uses a microsimulation to analyze the long-term consequences of the pandemic-related surgical delays. It looks at the 22,799 patients who were waiting for cancer surgery before the pandemic, and then looks at the waitlist of 20,177 patients during the pandemic, and the research team subjects them to different wait times.

“We subject them to what the regular wait times are, which on average prior to the pandemic, was about 25 days, and then the pandemic wait times, which on overage when the pandemic started was about 32 days,” Eskander said.

“Seven day difference seems like a very small difference, but when we took those patients and we put them through out health system in the model, we identified that those additional waits actually led to changes in survival.”

Eskander noted that all patients with cancer in Ontario, overall, lost a combined 843 life years due to surgery delays in the first wave of the pandemic.

“And, we only really modeled the first wave. We only really focused on the first six months of the pandemic so that number is probably much greater because we have subsequent waves with subsequent slowdowns,” he added.

The study also highlights that the results reported in the research paper are likely conservative estimates of the true impact of the COVID-19 pandemic on outcomes of patients with cancer.

The study noted while de-escalation of cancer surgeries during pandemics may be required, the slowdowns are associated with a risk of “unintended harm.”

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

Looking at the big picture, Eskander added the Ontario government should focus on a “holistic approach” that builds capacity in the health-care system, such that “even when our health-care system is pressed, we have the ability to continue with life saving and absolutely needed surgery.”

“In reality, in Ontario, our hospitals prior to the pandemic were already running at 100 per cent,” he said. “We’re still stuck trying to catch up and prioritize patients … What we really want to do is to create capacity in the system, where patients who need surgery should have free and open and equal access to it.”

“The only way to do that is to build more hospitals, build more operating rooms and provide more access to surgery in the health-care system.”

CANCER DIAGNOSIS FALLING THROUGH THE CRACKS

Eskander stated that another issue recognized in the study is many individuals are not even getting their cancer diagnosed in the first place due to pandemic-related issues.

“We’re behind even on picking up on cancers and even getting them through to treatment,” he said. “We know that there’s a number of cancers that are being diagnosed at a far lower rate than we would expect from prior to the pandemic.”

He said that often times cancers are diagnosed by accident on scans, including CT scans, MRIs and ultrasounds, but during the pandemic this imaging was not used as frequently as before due to disruptions in the health-care system.

He added that screening programs, which are meant to pick up on cancers during an early phase, were also disrupted during the pandemic.

“We still have a backlog. We haven’t quite caught up on our screening, but presumably as we catch up, we’re going to have a massive wave of cancer patients coming through the system,” he said.

Eskander added the final, and probably most important reason why cancer diagnoses are not happening as often as usual, is the lack of in-person medical appointments.

“I think virtual care is important and it’s here to stay, but I think seeing physicians virtually only, or predominantly, is a problem,” he said. “Because a lot of cancers that otherwise would be seen by a physician or felt on physical examination are missed and caught at a later time.” 

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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.

The Canadian Press. All rights reserved.

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