Presumption & Prevention

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Presumption & Prevention

49  articles in this collection
Written by Mathias Castonguay, Laurie-Anne Duquette, Camille Blouin, Noémie Desgagnés, 

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

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

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

What About Abortion?

Some evidence show that at-home medical abortion is preferable to other methods for pregnancy <9 weeks. Safety and efficiency of different methods are comparable. When surgical abortion is necessary, local anesthesia should be preferred to OR and general anesthesia. Phone call and video conference should be prioritised for necessary appointments.  If in-hospital abortion necessary, probable […]

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04/06/2020

Should We Manage Obstetric Ultrasounds Differently?

General considerations : The number of visits needs to be minimal and the patient should come alone. Triage based on risk factors and temperature at arrival should be performed before the patient enters the ultrasound unit. Non-urgent appointments should be postponed for 14 days. Monochorionic twin pregnancy should be managed as usual. Some high-risk pregnancy […]

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04/09/2020

Viral Load in Upper Respiratory Tracts

Viral loads seems to be higher soon after the symptom onset, with higher viral loads detected in the nose than in the throat. The results suggest a potential transmission potential by asymptomatic or minimally symptomatic patients, as the viral load in the asymptomatic patient was similar to the symptomatic ones.   These data come from […]

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04/03/2020

Urology Practice during the Outbreak

Urgent procedures that can be performed under local anesthesia are preferable considering the limited availability of anesthesiologists.  Gross hematuria should be treated to limit the use of blood derivatives. Non-deferrable oncological procedures should be planned while taking in consideration the patient comorbidity profile and the availability of intensive care beds. All procedures for benign diseases […]

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04/05/2020

Perioperative Management of Infected Patient

Management of the dedicated operating room(OR):  The OR should be adequately ventilated, ideally with negative pressure.  The same OR and the same anesthesia machine should be used for COVID-19 positive patients.  The anesthetic drug trolley should be kept in the induction room and all the drugs and equipment required for the procedure should be placed […]

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04/03/2020

Laparoscopy Procedure

Laparotomy should not be considered safer than laparoscopy in COVID-19 cases. Furthermore, laparotomy increase likelihood of prolonged hospital stays, intensive care stays and surgical complications. Although not well established, SAGES and CAGS recommend to assume that COVID-19 virus could be released in surgical smoke CO2 insufflation pressure should be kept to a minimum and an […]

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04/16/2020

Guidelines: Tracheotomy

Canadian Society of Otolaryngology-Head and Neck Surgery strongly advise against performing a tracheotomy in still infectious COVID-19 patients. In positive patients, requests for tracheotomy should generally not be considered regardless of duration of endotracheal intubation.  In emergency tracheotomy with unknown COVID-19 status:  Manage patient as if COVID-19 positive.  Intubation rather than tracheotomy is highly preferable. […]

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04/03/2020

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

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

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

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

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

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

The Attack on Hemoglobin: a Distraction or a Virulence?

This study suggests that structural and transcribed proteins of the virus may attack the β1-chain of hemoglobin leading it to release its porphyrin (just like the heme oxidase)1, 2. It also suggests that the virus can capture the free porphyrin and use it to enter the human cells, rather than only using the ACE2 and […]

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04/07/2020

Rationale of Favipiravir Against New Pandemic

Before COVID-19: Favipiravir is approved in Japan and China for treating severe influenza virus, as well as a promising prophylaxis and treatment of Ebola virus and treatment of Fever with Thrombocytopenia Syndrome.1   It was shown to be safe in several human clinical trials for influenza.1  It is renowned for its broad anti-RNA virus action1, and […]

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04/12/2020

Does Sickle Cell Disease Need Special Considerations?

About Immunocompetency: Functional hyposplenism in SCD (sickle cell disease) is not reported to increase the risk of viral infection in literature.1 However, infected patients with SCD may be more at risk of severe events. 2,3 About SCD treatments in patients without COVID-19 infection: Currently, no special adjustment of patient’s current medication is suggested4. It is […]

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04/12/2020

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

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

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

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