BackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region.MethodsThis study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period.ResultsThere were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave.ConclusionsThe COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.
Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Published population‐based data related to recourse to cystectomy, adoption of partial instead of radical cystectomy, determinants of perioperative mortality, complications and length of stay, pelvic lymphadenectomy, and type of urinary diversion, have been largely investigated in the USA, whereas evidence from Western and Southern Europe is lacking. This first population‐based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion, and a decreasing trend of length of stay and in‐hospital mortality. OBJECTIVE • To provide updated figures on urinary diversion, length of stay and mortality after cystectomy in two regions of northern Italy. PATIENTS AND METHODS • Discharge records of patients undergoing cystectomy for bladder cancer in 2000–2008 were extracted from the regional archives of hospital discharges. • Data on partial vs radical cystectomy and type of urinary diversion were obtained from intervention codes. • The influence of demographic characteristics, year of intervention, presence of comorbidities and hospital cystectomy volume on the adoption of a continent diversion and on in‐hospital mortality was assessed through multilevel models. RESULTS • The crude cystectomy rate was close to 10 per 100 000. • The share of partial cystectomies declined from 5.5% in 2000–2002 to 3.0% in 2006–2008. • A continent diversion was adopted in 35% of radical cystectomies, with higher rates in young male patients treated in high‐volume hospitals. • Median length of stay declined from 20 days in 2000–2002 to 18 in 2006–2008; in‐hospital mortality decreased from 3.2% to 2.2%. CONCLUSION • This first population‐based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion and a decreasing trend of length of stay and in‐hospital mortality.
This is the first Italian study to attempt to quantify the injury economic burden in a cohort of children: the costs imposed on society by injuries, suggest how important it is to commit resources to injury prevention.
Adverse drug reactions (ADRs) are a major health problem in the primary care setting, particularly among the elderly population. While the high frequency of ADRs in the elderly has several causes, a major and common determinant is polypharmacy, which can in turn increase the risk of drug-drug interactions (DDIs). In this paper, we analyzed the drugs prescriptions dispensed to elderly outpatients, to assess changes in the prevalence of selected DDIs in the period 2013–2019. Overall, about 15% of the patients aged >65 years were poly-treated. Among them, a decreasing trend in prevalence was observed for the majority of DDIs during the study period. This trend was particularly noticeable for DDIs involving fluoroquinolones and vitamin K antagonists, where a sharp reduction of over 40% was observed. On the opposite, a small increase in prevalence was observed for the association of antidiabetics and beta-blocking agents and for that of clopidogrel and PPIs. While the occurrence of most of the considered DDIs among poly-treated elderly decreased over time, the prevalence of some of them is still worrying. The complexity of the national drug formularies, as well as the increased number of prescribing actors that are involved, further urges the update of DDI lists to be used to monitor drug appropriateness and reduce avoidable ADRs.
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