Mindfulness-Based Interventions for Symptom Management in Children and Adolescents With Cancer: A Systematic Review

Tomlinson, D., Sung, L., Vettese, E., Murphy, S., & Plenert, E. (2020). Mindfulness-Based Interventions for Symptom Management in Children and Adolescents With Cancer: A Systematic Review| Journal of Pediatric Oncology Nursing| 1043454220944126.

Abstract

Psychological interventions have shown benefit in reducing symptoms in children and adolescents with cancer. More recently, mindfulness-based interventions (MBIs) have been shown to be a promising approach to symptom intervention in adolescents with chronic illnesses. In this systematic review, we aimed to describe MBIs or focused-breathing interventions that have been used to treat symptoms in children receiving cancer therapy. A systematic review was conducted using MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO from inception to September 2019. We identified relevant articles in which MBIs or focused-breathing interventions were the primary interventions delivered to improve symptoms in children or adolescents with cancer. Six studies met the inclusion criteria. MBIs included controlled breathing and belly breathing. Intervention effects were found to be beneficial with regard to symptoms that included procedural pain, distress, and quality of life. The interventions were generally well accepted and beneficial. All studies suffered limitations because of methodological flaws, including the lack of randomization, and small sample sizes. Despite the small numbers of studies and participants, MBIs delivered to children with cancer may have beneficial effects on certain symptoms. Implications for future research include interventions tailored to the specific symptom burden. Studies must aim to increase sample sizes as well as to include individuals at high risk for severe symptoms.

The Library & Knowledge Service can provide access to this article for Rotherham NHS Staff, request a copy here 

Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study #covid19rftlks

Sud, A. |2020|. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. The Lancet Oncology|DOI:https://doi.org/10.1016/S1470-2045(20)30392-2

Summary

Background

During the COVID-19 lockdown, referrals via the 2-week-wait urgent pathway for suspected cancer in England, UK, are reported to have decreased by up to 84%. We aimed to examine the impact of different scenarios of lockdown-accumulated backlog in cancer referrals on cancer survival, and the impact on survival per referred patient due to delayed referral versus risk of death from nosocomial infection with severe acute respiratory syndrome coronavirus 2.

Methods

In this modelling study, we used age-stratified and stage-stratified 10-year cancer survival estimates for patients in England, UK, for 20 common tumour types diagnosed in 2008–17 at age 30 years and older from Public Health England. We also used data for cancer diagnoses made via the 2-week-wait referral pathway in 2013–16 from the Cancer Waiting Times system from NHS Digital. We applied per-day hazard ratios (HRs) for cancer progression that we generated from observational studies of delay to treatment. We quantified the annual numbers of cancers at stage I–III diagnosed via the 2-week-wait pathway using 2-week-wait age-specific and stage-specific breakdowns. From these numbers, we estimated the aggregate number of lives and life-years lost in England for per-patient delays of 1–6 months in presentation, diagnosis, or cancer treatment, or a combination of these. We assessed three scenarios of a 3-month period of lockdown during which 25%, 50%, and 75% of the normal monthly volumes of symptomatic patients delayed their presentation until after lockdown. Using referral-to-diagnosis conversion rates and COVID-19 case-fatality rates, we also estimated the survival increment per patient referred.

Findings

Across England in 2013–16, an average of 6281 patients with stage I–III cancer were diagnosed via the 2-week-wait pathway per month, of whom 1691 (27%) would be predicted to die within 10 years from their disease. Delays in presentation via the 2-week-wait pathway over a 3-month lockdown period (with an average presentational delay of 2 months per patient) would result in 181 additional lives and 3316 life-years lost as a result of a backlog of referrals of 25%, 361 additional lives and 6632 life-years lost for a 50% backlog of referrals, and 542 additional lives and 9948 life-years lost for a 75% backlog in referrals. Compared with all diagnostics for the backlog being done in month 1 after lockdown, additional capacity across months 1–3 would result in 90 additional lives and 1662 live-years lost due to diagnostic delays for the 25% backlog scenario, 183 additional lives and 3362 life-years lost under the 50% backlog scenario, and 276 additional lives and 5075 life-years lost under the 75% backlog scenario. However, a delay in additional diagnostic capacity with provision spread across months 3–8 after lockdown would result in 401 additional lives and 7332 life-years lost due to diagnostic delays under the 25% backlog scenario, 811 additional lives and 14 873 life-years lost under the 50% backlog scenario, and 1231 additional lives and 22 635 life-years lost under the 75% backlog scenario. A 2-month delay in 2-week-wait investigatory referrals results in an estimated loss of between 0·0 and 0·7 life-years per referred patient, depending on age and tumour type.

Interpretation

Prompt provision of additional capacity to address the backlog of diagnostics will minimise deaths as a result of diagnostic delays that could add to those predicted due to expected presentational delays. Prioritisation of patient groups for whom delay would result in most life-years lost warrants consideration as an option for mitigating the aggregate burden of mortality in patients with cancer.

Read the full article from The Lancet Oncology

Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: the UK consensus position

British Journal of Cancer | 8th July 2020

This paper sought to seek consensus from UK clinicians with an interest in pancreatic cancer for management approaches that would minimise patient risk and accommodate for healthcare service restrictions.

The outcomes are described and include recommendations for treatment prioritisation, strategies to bridge to later surgical resection in resectable disease and factors that modify the risk–benefit balance for treatment in the resectable through to the metastatic settings.

Priority is given to strategies that limit hospital visits, including through the use of hypofractionated precision radiotherapy and chemoradiotherapy treatment approaches.

Full detail: Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: the UK consensus position

 

The Lancet Oncology: The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Research published in the journal Lancet Oncology underlines how the virus has disrupted services- for instance, cancer screening has been suspended, with urgent cases being prioritised, at the same time patients have also avoided healthcare. The researchers estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types: breast, colorectal, oesophageal and lung.

Summary

Background

Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types.

Methods

In this national population-based modelling study, we used linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15–84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1, 2010, and Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, 2012, and Dec 31, 2012, with follow-up data until Dec 31, 2015. We use a routes-to-diagnosis framework to estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. To model the subsequent impact of diagnostic delays on survival, we reallocated patients who were on screening and routine referral pathways to urgent and emergency pathways that are associated with more advanced stage of disease at diagnosis. We considered three reallocation scenarios representing the best to worst case scenarios and reflect actual changes in the diagnostic pathway being seen in the NHS, as of March 16, 2020, and estimated the impact on net survival at 1, 3, and 5 years after diagnosis to calculate the additional deaths that can be attributed to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data.

Findings

We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. Across the three different scenarios, compared with pre-pandemic figures, we estimate a 7·9–9·6% increase in the number of deaths due to breast cancer up to year 5 after diagnosis, corresponding to between 281 (95% CI 266–295) and 344 (329–358) additional deaths. For colorectal cancer, we estimate 1445 (1392–1591) to 1563 (1534–1592) additional deaths, a 15·3–16·6% increase; for lung cancer, 1235 (1220–1254) to 1372 (1343–1401) additional deaths, a 4·8–5·3% increase; and for oesophageal cancer, 330 (324–335) to 342 (336–348) additional deaths, 5·8–6·0% increase up to 5 years after diagnosis. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204–63 229 years.

Interpretation

Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer.

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

See also:

BBC News Coronavirus could lead to thousands more cancer deaths

Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus #covid19rftlks

Mehanna, H., Hardman, J. C., Shenson, J. A., Abou-Foul, A. K., Topf, M. C., AlFalasi, M., … & Fagan, J. J. (2020). Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. The Lancet Oncology.

Summary

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

Lancet Oncology: Organisations for patients with cancer feel the brunt of COVID-19 pandemic #covid19rftlks

Nelson, R. (2020). | Organisations for patients with cancer feel the brunt of COVID-19 pandemic|The Lancet Oncology | DOI:https://doi.org/10.1016/S1470-2045(20)30389-2

The ongoing COVID-19 pandemic has disrupted all facets of cancer care, from delaying diagnoses and treatment to halting clinical trials and biomedical research. Patient organisations have not been spared from the impact, with all aspects of their work affected, and in some cases, their very viability.To assess the impact of the pandemic in organisations for patients with cancer, a survey was done by a joint initiative of the World Ovarian Cancer Coalition, the World Pancreatic Cancer Coalition, the Lymphoma Coalition, the Advanced Breast Cancer Global Alliance, and the World Bladder Cancer Patient Coalitions. Responses were received from 157 member organisations located in 56 countries. Most of the responses came from the USA (28 responses) followed by Australia (ten), and then Canada, Italy, and the UK (eight each).

NICE: Cancer patients to benefit from new histology independent treatment

NICE | July 2020 | Cancer patients to benefit from new histology independent treatment

Entrectinib (Rozlytrek, Roche), a revolutionary treatment for a range of cancers, is the second histology independent drug to be recommended by NICE for use on the Cancer Drugs Fund (CDF).

As a histology independent treatment, entrectinib targets all solid tumours that have a certain genetic mutation (a neurotrophic tyrosine receptor kinase (NTRK) gene fusion), regardless of where the cancer originated in the body.

This is particularly beneficial to patients with some rare types of cancer where the treatments are currently limited.

The final draft decision is set to benefit adults and children 12 years and older, with advanced NTRK fusion-positive solid tumours, who have no satisfactory treatment options. Eligible patients will have access to entrectinib through the CDF once the marketing authorisation has been granted.

Further information available from NICE

Cancer care during and after the pandemic

Cancer care during and after the pandemic | BMJ (editorial) 2020; 370: m2622 | 2^nd July 2020

The covid-19 pandemic has had a drastic effect on the entire cancer continuum through interruption, delays, and altered modes of screening, diagnosis, and treatment as well as follow-up and palliative care.

This editorial makes the point that many of the strategies used to manage cancer care during the pandemic, such as remote consultations, are not new, and it is unfortunate that it took a pandemic to accelerate their adoption. It is critical that these innovations are not scaled down without examining their effect on patient outcomes (which may be both positive and negative) and equity of access.

Full editorial: Cancer care during and after the pandemic

Case 22-2020: A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic #covid19rftlks

Spring, L. M. et al. (2020) |A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic| NEJM |DOI: 10.1056/NEJMcpc2002422

Presentation of Case

Dr. Aditya Bardia: A 62-year-old woman was evaluated at this hospital after she had identified a mass in her left breast, confirmed by her physician on physical examination, during the pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The patient, who was of Ashkenazi Jewish ancestry, had no known family history of breast or ovarian cancer. Medical history included asthma and a fibroadenoma in the left breast, for which she had undergone excisional biopsy 30 years earlier. Menarche had occurred at 12 years of age and menopause at 54 years of age; she had not received hormone-replacement therapy.

Physical examination revealed a mass, measuring 3 cm in greatest dimension, in the left breast. No other masses or axillary lymph nodes were palpable. The patient underwent imaging studies in accordance with the American College of Radiology guidelines.¹ Both breasts were imaged, since the patient’s last mammogram had been obtained 7 years earlier.



Dr. Gary X. Wang: Mammography revealed an irregular mass with spiculated margins underlying the skin marker in the left breast, with imaging characteristics highly suggestive of cancer. Subsequent ultrasound examination revealed a solid, irregular mass in the left breast that measured 3.1 cm by 1.5 cm by 1.2 cm and normal left axillary lymph nodes. Tissue sampling with core-needle biopsy under ultrasonographic guidance was performed.

[NICE Guideline] Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer

NICE | 1 July 2020 | Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer

Evidence-based recommendations on atezolizumab (Tecentriq) for untreated extensive-stage small-cell lung cancer in adults.

Full details from NICE