Simple Summary The SARS-CoV-2 pandemic led to a significant disruption to healthcare. Cancer Trials Ireland is the national cooperative cancer trials organisation in Ireland. We analysed the impact of the pandemic on the conduct of cancer clinical trials over a 2 year period. Clinical trial accrual fell by 54%, with trials in radiotherapy being most affected, declining by 90%. This reduction was due to reduced staffing, delays in trial logistics and halting of accrual and initiations due to safety concerns. Remote monitoring of trials increased. Protocol violations increased due to interruption of visits and diagnostic testing. The impact on accrual persisted for at least 18 months. Significant central office staffing issues were evident with recruitment and retention. A retreat was conducted to identify the transformative changes that were needed to build resilience in clinical trial conduct. Adaptive strategies in trial conduct such as expanded telehealth and tele-monitoring, flexibility of trial scheduling, protected staff assignments, and mentoring of research staff were identified as priorities for the recovery stage of the pandemic. Abstract Background: Cancer Trials Ireland (CTI) is the national cooperative group in Ireland. The SARS-CoV-2 pandemic led to significant ongoing disruptive change in healthcare from March 2020 to the present day. Its impact and legacy on a national clinical trials organisation was assessed. Methods: A review was conducted of prospectively acquired communications, team logs and time sheets, trial activation, closure and accrual, for the period 2019 to September 2021. An online survey of the impact of the pandemic on clinical investigators and of clinical trials units was performed. A National Cancer Retreat was organised on 21 May 2021 to identify and address pandemic related disruption and develop adaptive strategies. Results: In the weeks after the pandemic was declared, remote working was initiated by all central office staff. Nationally, clinical trial accrual fell by 54% compared to the same period in 2019, radiotherapy trial accrual by 90%, and translational studies by 36%. Staff reassignment of research nurse staff occurred in 60% of units, trial monitoring was reduced in 42%, and trial initiations fell by 67%. Extreme fluctuations in monitoring hours were noted paralleling lockdown measures. Significant impact on all clinical trials units was noted including staff reassignments, reduced access to diagnostic imaging and reduced institutional supports. Remote clinic visits and remote monitoring was widely adopted. The National Cancer Retreat identified flexibility in trial conduct, staff recruitment and retention, the need for harmonisation of processes, and research staff support in the context of remote working as priorities. Conclusion: The pandemic has had a significant ongoing negative impact on cancer clinical trial activity in Ireland. Adaptive strategies including trial flexibility, expanded telehealth and remote monitoring, harmonisation of processes and staff support have been identified as priorities to ameliorate this impact, and develop a more sustainable clinical trial ecosystem.

/pdf/the-sars-cov-2-pandemic-and-cancer-trials-ireland-impact-w11d05yy.pdf

The SARS-CoV-2 Pandemic and Cancer Trials Ireland: Impact, Resolution and Legacy

Upon the COVID-19 pandemic onset in Ireland, cancer service disruptions occurred due to prioritisation of COVID-19 related care, redeployment of staff, initial pausing of screening, diagnostic, medical and surgical oncology procedures, staff shortages due to COVID-19 infection and impacts on the physical and mental health of cancer healthcare workers. This was coupled with reluctance among people with symptoms suspicious for cancer to attend for clinical evaluation, due to concerns of contracting the virus. This was further compounded by a cyber-attack on national health service IT systems on May 14th 2021. The Irish Cancer Society, a national cancer charity with a role in advocacy, research and patient supports, convened a multi-disciplinary stakeholder group (COVID-19 and Cancer Working Group) to reflect on and understand the impact of the pandemic on cancer patients and services in Ireland, and discuss potential mitigation strategies. Perspectives on experiences were gathered across domains including timeliness of data acquisition and its conversion into intelligence, and the resourcing of cancer care to address cancer service impacts. The group highlighted aspects for future research to understand the long-term pandemic impact on cancer outcomes, while also highlighting potential strategies to support cancer services, build resilience and address delayed diagnosis. Additional measures include the need for cancer workforce recruitment and retention, increased mental health supports for both patients and oncology professionals, improvements to public health messaging, a near real-time multimodal national cancer database, and robust digital and physical infrastructure to mitigate impacts of the current pandemic and future challenges to cancer care systems. 

https://figshare.com/articles/journal_contribution/Impact_of_the_COVID-19_pandemic_on_cancer_care_in_Ireland_-_perspectives_from_a_COVID-19_and_Cancer_Working_Group_/22269772/1/files/39595243.pdf

Impact of the COVID-19 pandemic on cancer care in Ireland – Perspectives from a COVID-19 and Cancer Working Group

Aims: To analyze the effect of COVID-19 pandemic on timely delivery of systemic anti-cancer treatment including chemotherapy, biological therapy and immunotherapy and assess complication rate. 
Place and Duration of Study: Department of Oncology, Dubai Hospital, Dubai, UAE from January 2020 to July 2020. 
Methods: This is a retrospective review of electronic medical records and infusion Centre log of the number of chemotherapy sessions administered in the infusion therapy Centre, Dubai hospital from January 2020 to July 2020. Data on treatment delays, interruptions or discontinuations, and adverse events such as febrile neutropenia were collected and analysed. 
Results: A total of 1553 systemic treatment sessions were recorded between January 2020 to July 2020 with an average of 222 treatment sessions per month. Physician recorded delays were observed in ninety (5.79%) treatment sessions. The average treatment delay was 7 (2-13) days. Delays were frequently caused by the overall treatment course and disease-related factors (toxicities, disease progression). The highest number of treatment delays (n=23,10.2%) were recorded in April, at the peak of the Covid-19 pandemic, most likely because of the implementation of extreme precautionary measures. There were no interruptions or discontinuations in treatment. 
Fourteen (<1%) patients developed febrile neutropenia. With treatment, all of them recovered fully. No significant change in systemic treatment related complications were observed during the pandemic. 
Conclusion: This study found no evidence of an appreciable rise in the number of complications or delays in systemic anticancer treatment during the COVID-19 pandemic. This experience indicates that systemic chemotherapy may be delivered successfully during a pandemic with infection control and safety precautions. However, more research with a larger sample size is needed for more accurate advice in this case.

Influence of Covid-19 Pandemic on Safe and Timely Delivery of Systemic Anti-Cancer Therapy, Dubai Hospital Experience

The first confirmed case of COVID-19 in Ireland was on February 29th 2020. From March until late April, the number of cases increased exponentially. The delivery of anti-cancer therapy during the COVID-19 pandemic was extremely challenging. In order to balance the benefits of continuing anti-cancer therapy with the associated increased hospital visits, combined with the risk of COVID-19 infection, we undertook a series of system changes in the delivery of cancer care. Patients who attended our dayward over a 4-month period were included. Data were obtained from patient and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 at two separate timepoints: prior to their visit via telephone, and using a symptom questionnaire on arrival at the hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab arranged. A total of 456 patients attended from January 1st to April 30th. The numbers of visits from January to April were 601, 586, 575, and 607, respectively. During this period, there were 2369 patient visits to the dayward and 1953 (82%) intravenous regimens administered. Of the 416 visits that did not lead to treatment, 114 (27%) were scheduled non-treatment review visits, 194 (47%) treatments were held due to disease-related illness, and 108 (26%) treatments were held due to treatment-related complications. Screening measurements were implemented on March 18th due to rising COVID-19 prevalence in the general population. Overall, 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. With careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID-19 pandemic is possible.

/pdf/delivery-of-systemic-anti-cancer-therapy-during-the-covid-19-5gecnlcwi3.pdf

Delivery of systemic anti-cancer therapy during the COVID-19 pandemic.

CN70 Patients with glioblastoma and seizures: Insights into care

CN30 Three stage capacity: Consent process for systemic anti-cancer therapy

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Delivery of systemic anti-cancer therapy during the COVID-19 pandemic.

CN70 Patients with glioblastoma and seizures: Insights into care

CN30 Three stage capacity: Consent process for systemic anti-cancer therapy