Oncologie

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Oncologie

Ressources pour la prise en charge des patients atteints de cancer

21  articles in this collection
Written by Mathias Castonguay, Camille Blouin, Noémie Desgagnés, Philippe Mercier, 

Cancer Research: A Silent Victim

COVID-19 has imposed serious and disruptive effects on hematology and oncology clinical trials, as thousands of cancer laboratories and clinical trials closed due to pandemic.1,2,3,4 Immediate consequences are already seen: Research staff and resources have been reassigned to manage the rush of patients at many academic institutions, therefore routine clinical research activities have been suspended.1,3,4  […]

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05/17/2020

Multiple Myeloma : Management Suggestions

Regarding smoldering multiple myeloma (SMM): Standard-risk patients should be monitored without active intervention, as usual. For high-risk patients, the possibility of enrollment in clinical trials might be limited; consider a conservative approach with close monitoring and observation. Regarding newly diagnosed active multiple myeloma (MM): All patients should be screened for COVID-19 before starting induction therapy. […]

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05/03/2020

Neuro-Oncologic Disease: Management Suggestions

Regarding surveillance and follow-up: Telemedicine appointments should replace routine in-clinic visits whenever possible. Outpatient radiology should remain accessible for patients and providers; radiology departments must establish protocols to limit risk of viral exposure for patients and staff. Regarding treatment and procedures: Consider whether treatment can be reasonably postponed until recovery; if it cannot, appropriate management […]

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04/27/2020

What’s New in Gynecologic Oncology?

General considerations : A balance between adequate individualized treatment and limited risk of exposure needs to be established. Where possible, telecommunication should be prioritised for appointments. If an in-hospital visit is necessary, the patient should preferably come alone.  Interventions such as labs and imaging studies could be postponed if the risk for recurrent/still present disease […]

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04/24/2020

Colposcopy During the Pandemic

Recommendations for diagnosis and treatment  Diagnostic testing for low-grade cervical cancer on screening can be deferred 6-12 months. LSIL, ASC-US, high-risk HPV with normal cytology  Low-grade intraepithelial lesion on biopsy (cervical/vaginal/vulvar) Diagnostic testing for high-grade cervical cancer on screening should be done within 3 months.  Procedures for high-grade cervical disease should be done within 3 […]

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04/22/2020

Colorectal Cancer: Management Suggestions

Regarding surveillance and follow-up: Telephone and telemedicine visits should replace routine in-clinic visits for nearly all patients. Minimize blood tests, scans and prescriptions. Strongly consider delaying routine surveillance scans and colonoscopies, as well as carcinoembryonic antigen (CEA) monitoring. In patients with metastatic disease and abnormal CEA, controlling CEA at intervals that scans would otherwise be […]

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04/19/2020

Impacts on Patients with Acute Leukemia

Missed or delayed diagnosis In the context of SARS-CoV-2 screening/diagnosis, full blood counts are performed only in a minority of symptomatic patients, as they are generally reserved to those with confirmed SARS-CoV-2 infection with associated signs of severity. The presenting symptoms of hematologic malignancies can be similar to those of COVID-19 infection; in fact, 50-75% […]

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04/17/2020

Localized Breast Cancer: Management Suggestions

Telemedicine should be prioritized for most encounters.1,2 Timing of surgery is mostly dictated by available resources and risk of infection specific to each center, as evidence demonstrates that preoperative delays may overall impact on BC (breast cancer) outcomes if no neoadjuvant therapies are used.1 About neoadjuvant and adjuvant systemic therapies: All BC subtypes ongoing neoadjuvant […]

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04/16/2020

Dermatological Surgery

Clinics should be triaged to review only urgent patients in person, and using telemedicine where possible. Consider cancelling all elective surgeries.  To minimize COVID-19 spread during office-based excisional surgery:  All surgical patients should be considered as potentially COVID-19 positive.  Smoke extractor systems are the most effective way to minimise risk. Using bipolar diathermy rather than […]

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04/16/2020

Metastatic Breast Cancer: Management Suggestions

Benefit of additional palliative chemotherapy for BC (breast cancer) may be small, therefore the risk: benefit ratio must be carefully discussed, keeping in mind the risk of exposition and the risk of immunosuppression.1 Oral treatments or home administration may be preferred to reduce the risk of exposure.1,2,3 Patients without symptoms of tumor progression may defer […]

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04/16/2020

Are Cancer Patients More Prone to Infection?

Cancer patients who are admitted for treatment (not necessarily active cancer treatment) seem to have increased susceptibility to COVID-19; older patients (>60 years) and patients with NSCLC (non-small cell lung cancer) appear to be at particular risk1. Hospital admissions and recurrent hospital visits, as well as the immunocompromised state of cancer patients undergoing treatment, are […]

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04/12/2020

Metastatic Prostate Cancer: Management Suggestions

Telemedicine should always be prioritized as well as laboratory monitoring rather than in-clinic visit to avoid exposures.1 Encourage patient to have enough supply of oral medications.1 Imaging may be differed if PSA is declining and in the absence of new symptom until deemed safe.1   Regarding RT (radiation therapy): RT for oligo-metastatic disease may be […]

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04/12/2020

Do Lung Cancer Patients Need Special Screening Strategy?

Regarding baseline risk of infection and death: Smoking history, is correlated with a higher incidence of respiratory infections and a 2.4 times higher risk of ICU admission, mechanical ventilation or death from COVID-19 infection. This may be due to structural and immunologic-induced modifications from tobacco; Alteration in the lung architecture from tumor mechanical obstruction (or […]

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04/10/2020

Localized Prostate Cancer: Management Suggestions

In most cases, minimal harm is expected with delays of 3-6 months, especially when estimating the risk: benefit ratio within mind the mortality related to COVID-19. Telemedicine should always be prioritized as well as laboratory monitoring rather than in-clinic visit to avoid exposures.  About staging, surveillance and timing of treatment: For low risk cancer (very […]

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04/10/2020

Cancer Surgery in the Time of Pandemic

Cancer surgery patients should be considered “essential” and they should be among the last group of to be delayed.  In case a hospital cannot carry out non-emergency surgeries, a jurisdictional coordination should facilitate transfer care of cancer patients to less overwhelmed institutions, rather than delaying surgery.  In spite of that, triage of cancer surgery cases […]

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04/10/2020

Advanced Lung Cancer: Management Suggestions

Patients with lung cancer are more at risk of pulmonary complications from COVID-19 disease and the risk: benefit ratio of systemic anticancer treatment has to be considered.1,2 Practical suggestions to treat patients are proposed (see table 1 below).2 Regarding Potential Surgery: Stage IIIA should be considered urgent and surgery should be done within one month […]

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04/07/2020

Effective Measures to Prevent Transmission in the Oncology Department?

Mandatory measures have been carried out at the National Cancer Center in China: Multiple on-site temperature tests were be performed (entrances of hospital, outpatient clinic, wards); Online appointments were offered. If not doable, essential personal protective measures were implemented (wearing mask, bringing disinfectant); For patients preparing to be admitted, symptoms that are potentially associated with […]

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04/07/2020

Theoretical Dangers in Using Immune Checkpoint Inhibitors

ICI (immune checkpoint inhibitors) and immunocompetence. Hematological irAEs (immune related adverse event) are uncommon, as ICI secondary autoimmune thrombocytopenia and neutropenia, antibody-mediated hemolytic anemia and thrombotic thrombocytopenic purpura are rare. Their impact may actually be beneficial in countering the tumoral immunosuppressive microenvironment. Considering the potential anti-PD1/PD-L1 pneumological toxicity. As already known, the presence of an […]

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04/05/2020

Dilemmas Regarding Oncology Care System

Delaying Treatment or Accepting Harm of Exposure? Many solid tumors (such as lung or pancreatic cancer) and some hematologic cancer (such as acute leukemia or aggressive lymphomas) require immediate diagnosis and treatment, opposed to other common early-stage cancers (breast, prostate, cervical, nonmelanoma skin…) that may not need immediate action and therefore prevent unnecessary exposition. For […]

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04/04/2020

Stratifying the Risk Among Cancer Patients

Prior anti-tumor treatment within 14 days before COVID-19 diagnosis is a major risk factor for developing severe events.1 Patchy consolidation on the first CT on admission is a major risk factor for developing severe events.1 Patients with blood cancer and metastatic cancer seem to have a higher risk of severe events compared to patients without […]

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03/29/2020

Risk of Severe Events in Cancer Patients

Patients with cancer have a higher risk of severe events and death compared with patients without cancer.1,2 Patients who underwent chemotherapy or surgery in the past month had higher risk.1 In Italy, it was found that 20% of patient who died from COVID-19 had an active cancer. 2   Wenhua L and al. conducted a […]

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03/28/2020