Objective This literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team. Data Sources Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google Scholar up until September 2020. Conclusion While the safe and effective delivery of cancer care via telehealth requires education and training for healthcare professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes. Implications for Nursing Practice Global public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the “hub of cancer care” safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.
Stereotactic body radiotherapy (SBRT) can delay escalation to systemic treatment in men with oligometastatic prostate cancer (PCa). However, large, prospective studies are still required to evaluate the efficacy of this approach in different patient groups. This is the interim analysis of a prospective, single institution study of men relapsing with up to five synchronous lesions following definitive local treatment for primary PCa. Our aim was to determine the proportion of patients not requiring treatment escalation following SBRT. In total, 199 patients were enrolled to receive fractionated SBRT (50 Gray in 10 fractions) to each visible lesion. Fourteen patients were castration resistant at enrolment. The proportion of patients not requiring treatment escalation 2 years following SBRT was 51.7% (95% CI: 44.1–59.3%). The median length of treatment escalation‐free survival over the entire follow‐up period was 27.1 months (95% CI; 21.8–29.4 months). Prior androgen deprivation therapy (ADT) predicted a significantly lower rate of freedom from treatment escalation at 2 years compared to no prior ADT (odds ratio = 0.21, 95% CI: 0.08–0.54, p = 0.001). There was no difference in the efficacy of SBRT when treating 4–5 vs. 1–3 initial lesions. A prostate‐specific antigen (PSA) decline was induced in 75% of patients, with PSA readings falling to an undetectable level in six patients. No late grade three toxicities were observed. These interim results suggest that SBRT can be used to treat up to five synchronous PCa oligometastases to delay treatment escalation.
BackgroundIntravesical Bacillus Calmette–Guérin (BCG) remains the standard adjuvant treatment for non-muscle invasive bladder cancer (NMIBC) following transurethral resection; however, BCG failure and related toxicities are common.ObjectivesTo compare the efficacy and toxicity of intravesical BCG and gemcitabine in the treatment of NMIBC.MethodsRetrospective data were collected in the region of Canberra, Australia from January 2010 to December 2015. The survival cutoff was December 2016. Primary end point was disease-free survival (DFS) and secondary end point was toxicity. After optimal transurethral resection all patients received weekly intravesical BCG or gemcitabine for 6 weeks and maintenance treatment according to their risk. The recurrence was defined as histology proven tumor recurrence (any grade), or appearance of carcinoma in situ.ResultsOne hundred and three patients were evaluable, 52 treated with BCG and 51 with gemcitabine with a median age of 77 and 78, and were mostly male. Approximately half of each received maintenance therapy. The groups were well balanced, apart from some difference in cancer risk groups. Twenty-one percent in the BCG group and 29% in the gemcitabine group had received prior BCG. Median follow up was 15.0 months. Median DFS was 19.6 months for BCG, whereas median DFS was not reached with gemcitabine. There was a trend toward improved DFS with gemcitabine in multivariate analysis, HR: 0.49 (95% CI: 0.22–1.06, p = 0.07). Adverse events were significantly less frequent with gemcitabine (7 versus 44%, p ≤ 0.05). There were four cases of systemic BCG infection.ConclusionIntravesical gemcitabine was associated with a trend toward better DFS with significantly lower toxicity when compared with BCG. Intravesical BCG remains the standard first-line adjuvant therapy; however, intravesical gemcitabine could be a reasonable alternative in cases where BCG is contraindicated and for patients who are intolerant or refractory to BCG. A prospective phase 3 trial is needed to confirm the benefits of gemcitabine over BCG.
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