Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

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David Rain
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

COVID-19 Pandemic and the New State of Oncology Practice: An Editorial

Hani Ashamalla, Mark Ashamalla, Samy I. McFarlane*

Department of Medicine, Downstate -Health Science University, Brooklyn, NY USA

Abstract:

Keywords: COVID-19, SARS-Cov-2, oncology practice, cancer

Received June 01, 2020; Revised June 05, 2020; Accepted June 08, 2020

Citation: Hani Ashamalla, Mark Ashamalla, Samy I. McFarlane, COVID-19 Pandemic and the New State of Oncology Practice: An Editorial. American Journal of Medical Case Reports, 8 (9). 311-312. January 2020. doi:10.12691/ajmcr-8-9-13

The novel coronavirus disease 2019 (COVID-19) is a modern- day pandemic that started in Wuhan city, Hubei province in China in December 2019 and spread throughout the world affecting people in over 180 countries. To-date, the pandemic has claimed over 360,000 lives worldwide mainly due to severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) as well as multi-organ failure including thromboembolic strokes and acute myocardial infarctions. This pandemic has overwhelmed health care systems in the USA, Europe and many other countries around the globe. Among the high-risk populations with increased morbidity and mortality from COVID-19 are the elderly, people with diabetes, immunocompromised patients and those with co-morbid conditions such as cardiovascular disease as well as those with cancer. In this editorial, we present the unique, and challenging, relationship between COVID-19 and cancer, highlighting the higher risk of COVID and the higher burden of complications among cancer patients. We also present strategies proposed to mitigate the heightened risk associated with the new COVID-cancer state.

One of the first articles that reported on the increased incidence of COVID-19 state among cancer patients was by Whehua Liang and associates [1]. This prospective cohort study that was conducted by the National Clinical Research Center for Respiratory Disease, together with the National Health Commission of the People's Republic of China to monitor COVID-19 cases have collected and analyzed 2007 cases from 575 hospitals in 31 provincial administrative regions [1]. In this study, cancer was 3 times higher among COVID-19 patients, compared to the overall Chinese population [1], with a prevalence of 2.2%, which is 1.7 times higher than that of the Chinese population of the same age according to the International Agency for research on cancer [2]. Patients with cancer have also been found to have more severe symptoms with COVID-19, compared to non-cancer patients; Yang and colleagues [3] observed worsening acute respiratory syndrome in COVID cancer patients. Similarly, Whehua and associates [1] observed that the percentage of patients being admitted to intensive care units requiring ventilation, or ultimately dying, was 39% compared to 8% in non-cancer patients (p=0.0003).

The etiology of why COVID cancer patients are more prone to worsening presentation or death is not as clear. Some have advocated a blunted immune response [4], while others have attempted to blame the underlying host related factors that may have initially caused the cancer such as smoking and increased lung injury. [5,6] Cytotoxic anti-cancer treatments may also be contributing factors. [7]

However, patients who are in need of active cancer therapy in the COVID state suffer from significant delays for very obvious reasons.

Several have attempted to mitigate the risk of delaying oncologic care; Nagar and Formenti warned about the deleterious effects of delaying radiotherapy. [8], while, Kutilov and associates [9] recommended an adaptive delay policy based on the type and stage of cancer (early-stage breast, prostate, cervical, non melanomatous skin), deemed more possible to be postponed, while others like acute leukemia, lung and pancreatic neoplasms cannot be.

While many consensuses and guidelines are provided by Oncology societies such as American Society for Radiation Oncology (ASTRO) and/or the European Society for Radiotherapy (ESTRO), we are still left with several dilemmas on many fronts:

A) Patients and families:

- Reduced family and social support due to COVID constraints will place undue strain on patients’ tolerance and compliance with treatment.

- Transportation: many cancer patients are dependent on others to bring them in for their treatments while others live in fear of using public transportation.

B) Facilities:

- Social distancing: while it had been temporarily easier to comply with during the acute COVID state with fewer patients to handle, significant changes on the configuration of waiting areas, infusion chairs,…etc. will have to accommodate larger numbers of patients as tensions and restrictions are eased.

- Reduction of the duration of regimens: many radiation oncology centers had adopted hypofractionated regimens to lessen the frequency of visits. While many of these regimens have a high level evidence basis, some are being adopted due to the pandemic constraints without level-1 evidence for their utility.

- Confusion and constant changes in published messages: as much as we know about patients who have tested positive, there remains even more to be learned on how to manage those who continue to keep shedding the virus remaining positive for weeks after their first test. The constantly changing paradigms may negatively affect health care workers as well as patients who are negative for the virus.

C) Patient-doctor relationship:

Because of social distancing and use of face masks, this long treasured relationship is under significant strain. The bond with our cancer patients and the empathy health care providers are known for is not easily conveyed from behind a mask. On the other hand, a patient’s facial expressions may not be easily detected by the treating team and hence, we now face a disruption of one of the most important bonds we have with our cancer patients.

D) Clinical trials:

While it is considered part of standard of care in many institutions, the poetical need for extra visits just to comply with the design of the studies may result in decreased accrual.

E) Loss of financial support and/or insurance:

Many cancer patients who were laid off during the pandemic are now very concerned with how to begin or resume their care, and if the government stimulus will allow extension of their insurance coverage even when they are unemployed.

F) Psychological impact of COVID Cancer State:

The deleterious effects of COVID on the psychological wellbeing of previously unaffected individuals are emerging. At the same time, the synergistic effects of the COVID Cancer State on the psychological wellbeing promises to be more additive.

G) COVID Cancer state:

While oncologists are warning against the deleterious effects of delaying anti-cancer therapy, there remain several facets of this complex crisis yet to be uncovered; should we be more concerned about chronic effects of the virus on many organs especially in patients with cytokine release syndrome [10] or multiple organ inflammation that may render patients more susceptible to the adverse effects of chemotherapy?

These puzzles and more are slowly but surely being uncovered and in some instances properly addressed. However, it is a new phenomenon that we are facing in Oncology and we ought to be ready to face it as a state of practice rather than a fleeting syndrome for several months if not years.

Conflicts of Interest

The authors had no conflicts of interest.

Acknowledgements

This work is supported, in part, by the efforts of Dr. Moro O. Salifu M.D., M.P.H., M.B.A., M.A.C.P., Professor and Chairman of Medicine through NIH Grant number S21MD012474.

References

[1]   | Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020; 21(3): 335‐337.
[2]   | J. Ferlay, M. Ervik, F. Lam, et al. Global Cancer Observatory: Cancer Today International Agency for Research on Cancer, Lyon, France (2018). https://gco.iarc.fr/today, Accessed 5th Apr 2020
[3]   | Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Clinical characteristics and outcomes of cancer patients with COVID-19 [published online ahead of print, 2020 May 5]. J Med Virol. 2020; 10.1002/jmv.25972.
[4]   | Schreiber RD, Old LJ, Smyth MJ. Cancer immunoediting: integrating immunity’s roles in cancer suppression and promotion. Science 2011; 331: 1565-70.
[5]   | Cai G. Bulk and single-cell transcriptomics identify tobacco-use disparity in lung gene expression of ACE2, the receptor of 2019-nCov. medRxiv 2020.
[6]   | Xia Y, Jin R, Zhao J, Li W, Shen H. Risk of COVID-19 for patients with cancer. Lancet Oncol. 2020; 21(4):e180.
[7]   | Kattan J, Kattan C, Assi T. Do checkpoint inhibitors compromise the cancer patients' immunity and increase the vulnerability to COVID-19 infection?. Immunotherapy. 2020; 12(6): 351-354.
[8]   | Nagar, H., Formenti, S.C. Cancer and COVID-19 — potentially deleterious effects of delaying radiotherapy. Nat Rev Clin Oncol (2020).
[9]   | Kutikov A, Weinberg DS, Edelman MJ, Horwitz EM, Uzzo RG, Fisher RI. A War on Two Fronts: Cancer Care in the Time of COVID-19 [published online ahead of print, 2020 Mar 27]. Ann Intern Med. 2020; M20-1133.
[10]   | Shimabukuro-Vornhagen A, Gödel P, Subklewe M, et al. Cytokine release syndrome. J Immunother Cancer. 2018; 6(1): 56. Published 2018 Jun 15.