Introduction
Coronavirus disease 2019 (COVID-19) has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak impacted on access to cancer diagnosis and treatment for LC pts compared to pre-pandemic time.
Methods
Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared to the same period in 2019. Differences between the two years were analyzed using chi-square test for categorical variables and Mann-Whitney U test for continuous variables.
Results
A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 vs 1637, p=0.09). Newly LC pts in 2020 were more likely to be diagnosed with stage IV disease (p<0.01) and to be current smokers (p<0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% vs -3.2%) compared to the other months included. More LC pts referred to low/medium volume hospital in 2020 compared to 2019 (p=0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (p=0.94), symptoms onset and cytohistological diagnosis (p=0.92), symptoms onset and treatment start (p=0.40), treatment start and first radiological revaluation (p=0.36).
Conclusions
Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.
During 10 years of activity at our Service, we collected 1867 cases of poisoning in children. Our observations concern only subjects hospitalized at our Institute and do not include phone call consultations. Our experience confirmed a higher number of poisonings among males. As far as age was concerned, the highest percentage of cases involved children under five, with a peak between 2 and 3 years of age. A fairly high incidence (8%) of "passive" poisonings was found in infants in their first year of life as a consequence of mistakes by the mother or other people taking care of the child. Voluntary poisonings, occurring in children aged 9 or more, often involved females and accounted for 2.1% of the total. Drugs are the main cause of poisoning in children, followed by household products and by a group of different substances (spoiled foods, nonedible mushrooms, alcoholic beverages). The lowest number of poisonings occurred on Sundays. The time of the day when most accidental poisonings occurred ranged from 10:00 AM to 12:00 noon and from 6:00 to 8:00 PM. Most poisonings took place in the kitchen. The colors preferred by children are white and pink.
Immunotherapy has revolutionized the treatment paradigm of non-small cell lung cancer and improved patients’ prognosis. Immune checkpoint inhibitors have quickly become standard frontline treatment for metastatic non-oncogene addicted disease, either as a single agent or in combination strategies. However, only a few patients have long-term benefits, and most of them do not respond or develop progressive disease during treatment. Thus, the identification of reliable predictive and prognostic biomarkers remains crucial for patient selection and guiding therapeutic choices. In this review, we provide an overview of the current strategies, highlighting the main clinical challenges and novel potential biomarkers.
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