Background: COVID-19 pandemic deeply affected cancer patient management, increasing the burden on their caregivers (CG), who are already overwhelmed. We aimed to identify COVID-19-related challenges and the overload burden experienced by CGs.Methods: Between March and May 2020, 40 CG designated by cancer patients were phone interviewed based on a questionnaire. CGs were requested to enumerate regular and new tasks they have been performing for the care recipient and report caregiving-related challenges faced during the COVID-19 outbreak, coping strategies and unmet needs.Results: CGs were mainly women (67%). Median age was 42 years. they were the spouses in 30% of cases, children in 58% and siblings in 12%. CG lived with the patients in 57% and 18% moved-in with the care recipient during the lockdown. The 25% CG smokers reported an increase in the daily number of cigarettes. All CGs reported strict adhesion to safety precautions; 63% stockpiled food and medical supplies due to panicking. They reported difficulties in obtaining cancer and non-cancer related drugs in 30% of cases. Transportation to and from the hospital was more difficult in 30% of cases, affecting significantly chemo-sessions attendance (p¼0.001). 52% of CGs believed that cancer was more serious than COVID-19 and 45% thought that both were equally serious. 13% decided to miss chemotherapy sessions fearing contagion. CGs were deeply worried that their care recipient might get worse in 92% of cases, 55% feared they might be denied intensive care if they caught the virus because of cancer. Additional financial burden was caused by expenses to buy sanitizer gel and face masks in 77% and transportation in 23%. Increased anxiety was reported in 82% of CGs, 58% had sleep disorders, 7% took sleeping pills. 97% of CGs were satisfied with new screening measures in our medical oncology department while 15% faced communication problems with health workers. Reported unmet needs were: 23 % transportation difficulties, 3% lack of financial support, 18% lack of cancer-related information, 40% lack of psychological support.Conclusions: CGs seemed suffering from an additional burden due to COVID-19 spread logistically, financially, physically and emotionally highlighting the lack of planned strategies in such unprecedented situation.Legal entity responsible for the study: Abderrahman Mami Hospital.
Background: Lung cancer diagnosed solely with intrathoracic metastases are classified as M1a, but intrathoracic metastases can be further divided into different patterns. The objective of our study was to analyze the survival difference between different metastatic patterns of intrathoracic metastases in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations. Methods: EGFR-mutant patients diagnosed only with intrathoracic metastasis between March 2011 and October 2016 were collected. Prognosis was analyzed according to metastatic patterns based on univariate and multivariate analysis. Results: A total of 137 patients (60 patients who only had pleural metastasis [Group A], 44 patients who only had contralateral lung metastasis [Group B] and other 33 patients had both pleural and contralateral lung metastasis with or without pericardial effusion [Group C]) were included in the study. The median OS (overall survival) times were 38.1(95%confidence interval [CI]: 27.8-48.4), 35.7(95%CI: 23.4-48.0), and 29.7(95%CI: 22.8-36.6) months for Group A, Group B, and Group C, respectively (p ¼ 0.037). Multivariate analysis demonstrated that Group A and Group B had longer OS than Group C (hazard ratio [HR]¼0.524, 95%CI: 0.307-0.894, p ¼ 0.018; HR ¼ 0.473, 95%CI: 0.241-0.931, p ¼ 0.030, respectively) among lung adenocarcinoma patients with EGFR mutation. With regard to patients with pleural or contralateral metastasis only, OS benefit (p ¼ 0.579) was not significant between the two groups. Subgroup analysis demonstrated that the OS benefit of Group A was significant in patients with N0-1 disease and 21L858R mutant but not in EGFR exon 19 deletion, N2-3 stage and T3-4 stage disease patients. Conclusions: The prognosis of EGFR-mutant lung adenocarcinoma patients diagnosed only with intrathoracic metastasis is different, indicating that M1a may should be refined in the future.
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