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Introduction To analyze COVID-19 mortality in cancer patients and associated factors such as age, sex, type of insurance, situation at COVID-19 diagnosis, and cancer histology during the pandemic at a cancer center in Brazil. Methods Cross-sectional study carried out from April 02, 2020 to August 31, 2020 at A.C. Camargo Cancer Center (ACCCC), in São Paulo, Brazil. Cases were extracted from the Hospital Cancer Registry. COVID-19 lethality rates by histology were calculated; multiple logistic regression was used to identify factors associated with COVID-19 mortality. The log-rank test was applied to compare the survival curves for each variable. Results Of the 411 patients analyzed, 51 (12.4%) died due to COVID-19. Death occurred at an average age of 63 years. The fatality rate was higher for lung (0.333) and hematological (0.213) cancers and was associated with age over 60 years. The greatest chances of death from COVID-19 were in cases of lung (odds ratio, OR, 4.05, 95% confidence interval, CI 1.33–12.34) and hematological (OR 2.17, 95% CI 0.96–4.90) cancers, and in patients currently undergoing cancer treatment (OR 2.77, 95% CI 1.25–6.13). There were no statistical differences in survival by sex, age group, type of insurance, situation at the diagnosis of COVID-19, and histology of cancer for COVID-19. Conclusions Mortality due to COVID-19 in cancer patients is heterogeneous. These findings reinforce the need for individualized strategies for the management of different types of cancer that reduce the risk of death from COVID-19.

How to cite this article: Leite FPM, Curi C, Sanches SM, et al. How to maintain elective treatment of breast cancer during the COVID-19 pandemic-A cancer center experience.

Background To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. Methods Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. Results COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17–1.42) and women (SMR 1.2, 95% CI 1.06–1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67–2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. Conclusion There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.

There are scarce epidemiological studies on lung cancer mortality in areas exposed to asbestos in developing countries. We compared the rates and trends in mortality from lung cancer between 1980 and 2016 in a municipality that made extensive use of asbestos, Osasco, with rates from a referent municipality with lower asbestos exposure and with the rates for the State of São Paulo. We retrieved death records for cases of lung cancer (ICD-9 C162) (ICD-10 C33 C34) from 1980 to 2016 in adults aged 60 years and older. The join point regression and age-period-cohort models were fitted to the data. Among men, there was an increasing trend in lung cancer mortality in Osasco of 0.7% (CI: 0.1; 1.3) in contrast to a mean annual decrease for Sorocaba of -1.5% (CI: −2.4; −0.6) and a stable average trend for São Paulo of -0.1 (IC: −0.3; 0.1). Similar increasing trends were seen in women. The age-period-cohort model showed an increase in the risk of death from 1996 in Osasco and a reduction for Sorocaba and São Paulo State during the same period. Our results point to a need for a special monitoring regarding lung cancer incidence and mortality in areas with higher asbestos exposure.

The present study was conducted to evaluate the socioeconomic inequality related to lung cancer mortality rates and trends between 2000 and 2015 according to gender in Brazil. We retrieved the death records for cases of lung cancer (ICD-10 C33 C34) from 2000 to 2015 in adults age 30 years and older in Brazilian Regions from official databases (DATASUS) and corrected for ill-defined causes. The Prais-Winsten regression method and Pearson correlation were applied. The results were considered statistically significant when p < 0.05. The correlation between the lung cancer mortality rates and the HDI decreased when the rates for the first and last years of the historical series were compared in men (r = 0.77; r = 0.58) and women (r = 0.64; r = 0.41). However, the correlation between the trends in the lung cancer mortality rates and the HDI was negative in men (r = − 0.76) and women (r = − 0.58), indicating larger reductions (or smaller additions) among the Federative Units with the highest HDI, in contrast to trends reflecting a greater increase in those with the lowest HDI. Our results suggest a relevant inequality in the trends of mortality from lung cancer in Brazil.

Vocational rehabilitation (VR) aims at improving work ability to facilitate workers’ return to work. VR is provided in Brazil by the public social security system. The aim of the present study was to analyze trends in VR indicators for Brazil from 2007 to 2016. Based on open-access, secondary aggregate data, we calculated the cumulative incidence of VR indicators. We fitted Prais-Winsten generalized linear regression models to estimate trends and calculated annual percent variation with the corresponding 95% confidence interval (95% CI). The mean cumulative incidence of referrals to VR services was 37.16/1000 temporary disability benefits granted and exhibited a decreasing trend of −6.92% (95% CI: −8.38; −5.43). The mean cumulative incidence of admissions to VR services was 57.34/100 referrals and exhibited an increasing trend of 3.31% (95% CI: 1.13; 5.53). The mean cumulative incidence of rehabilitation was 57.43/100 admissions and remained stable along the analyzed period, −2.84 (95% CI: −5.87; 0.29). Our findings evidence a reduction in the number of workers referred for VR, an increase of admissions, and stability in the cumulative incidence of rehabilitated workers.

Background: In low-and middle-income countries, such as Brazil, studies on the causes of death in asbestos-exposed workers are scarce. Methods: A cohort study was performed involving 988 males who had worked in the asbestos-cement industry in the state of São Paulo, with a total of 12,217 personyears of observation between 1995 and 2016. The standardized mortality ratio (SMR) stratified by age was calculated as the ratio between the observed rate and the expected rate in the state of São Paulo. Results: Increased SMRs were observed for overall mortality (SMR 1.1, 95% confidence interval [CI], 0.98-1.23) and mortality due to pleural malignant neoplasms