PDF(Pubmed)
Abstract：
BACKGROUND: The COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs).
METHODS: We reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).
RESULTS: Two window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.
CONCLUSIONS: Based on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.
METHODS: We reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).
RESULTS: Two window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.
CONCLUSIONS: Based on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.
摘要：
背景：COVID-19大流行已被证明是医疗保健系统的历史性挑战，特别是癌症患者。到目前为止,关于对综合护理途径(ICPs)的影响的数据非常有限.
方法：我们回顾了在COVID-19大流行前后进入威尼托肿瘤研究所（IOV）/帕多瓦大学医院（中心1）和维罗纳大学医院（中心2）的肺癌患者的ICP，通过多学科团队（MDT）成员选择的16项指标。
结果：选择了两个窗口期（2019年3月和2020年4月）进行比较。早期NSCLC患者的内窥镜诊断程序和主要切除在中心1增加，在该中心为癌症患者建立了与专门人员的优先途径。在成为COVID单元一部分的中心2观察到轻微下降。人员短缺和肿瘤样本的不同处理方法确定了两个中心完成诊断途径的时间稍长。人员保护策略导致了网络基础上的MDT重塑，并在两个中心中讨论了大量案例。优化患者进入医疗机构的机会减少了首次门诊肿瘤就诊，患者参加临床试验，和终末期癌症系统治疗；最后，作为早期和局部晚期NSCLC的放射治疗方法,大分割的比例较高.
结论：根据两个中心的经验，我们确定了受COVID-19大流行影响的ICP的关键步骤,从而积极主动地为胸部肿瘤学提供强有力的服务.
方法：我们回顾了在COVID-19大流行前后进入威尼托肿瘤研究所（IOV）/帕多瓦大学医院（中心1）和维罗纳大学医院（中心2）的肺癌患者的ICP，通过多学科团队（MDT）成员选择的16项指标。
结果：选择了两个窗口期（2019年3月和2020年4月）进行比较。早期NSCLC患者的内窥镜诊断程序和主要切除在中心1增加，在该中心为癌症患者建立了与专门人员的优先途径。在成为COVID单元一部分的中心2观察到轻微下降。人员短缺和肿瘤样本的不同处理方法确定了两个中心完成诊断途径的时间稍长。人员保护策略导致了网络基础上的MDT重塑，并在两个中心中讨论了大量案例。优化患者进入医疗机构的机会减少了首次门诊肿瘤就诊，患者参加临床试验，和终末期癌症系统治疗；最后，作为早期和局部晚期NSCLC的放射治疗方法,大分割的比例较高.
结论：根据两个中心的经验，我们确定了受COVID-19大流行影响的ICP的关键步骤,从而积极主动地为胸部肿瘤学提供强有力的服务.
