PURPOSE While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. METHODS This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. RESULTS In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (−74%), new patient E&M visits (−70%), and established patient E&M visits (−60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (−26%) and July (−31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. CONCLUSION The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.
As many biosimilars come to market in the next several years, their use in oncology will play an important role in the future care of patients with cancer. ASCO is committed to providing education and guidance to the oncology community on the use of biosimilars in the cancer setting; therefore, ASCO has developed this statement to offer guidance in the following areas: (1) naming, labeling, and other regulatory considerations, (2) safety and efficacy of biosimilars, (3) interchangeability, switching, and substitution, (4) value of biosimilars, and (5) prescriber and patient education.
This study analyses the performance of the financial sector with respect to corporate social responsibility and sustainability. Because this sector has a strong influence economically and on sustainable development, both risk management issues and stakeholder pressure drive the financial sector into a more sustainable direction. In contrast to polluting sectors, the financial sector does not affect the environment and society by direct emissions or the use of resources like other industries. To compare the financial sector with other sectors regarding their sustainability performance, we analyzed the performance in the fields of sustainability reporting, business ethics and product responsibility, labor issues, environmental performance, community issues, and corporate governance. The study is based on more than 1800 firms including 400 organizations from the financial sector. We link CSR to sustainability and define it as corporate self-regulation in order to manage sustainability risks and opportunities. The results suggest that financial sector performance is relatively low regarding corporate social responsibility (CSR) in general. Weaknesses of the financial sector with regard to CSR are reporting, business ethics and product responsibility, and labor issues. Strengths of the financial sector regarding CSR can be located with respect to community relations. Further research is needed with respect to the factors influencing CSR performance. It is still not clear what influences regulations, stakeholder pressure or potential financial benefits have on sustainability performance in the financial sector.
Secondary hormone therapy, chemotherapy, and bisphosphonate therapy may provide benefits for selected patients. Correlation of disease stage with biologic characteristics of the tumor and host facilitates proper choices of interventions. Docetaxel-based chemotherapy regimens should be considered for first-line treatment of patients with progressive metastatic AIPC.
Objectives: Several studies suggest the sensitivity of chest computed tomography (CT) is far greater than that of reverse transcription polymerase chain reaction (RT-PCR) in diagnosing COVID-19 patients, and therefore, CT should be included as a primary diagnostic tool. This systematic review aims to stratify studies as high or low risk of bias to determine the true sensitivity of CT for severe acute respiratory syndrome coronavirus-2 infection according to the unbiased (low risk) studies, a topic of particular importance given the insufficient quantity of RT-PCR kits in many countries. We focus on sensitivity as that is the chief advantage perceived of CT. Materials and Methods: This systematic review involved searching the PubMed and Google Scholar databases for articles conducted and published between January 1 and April 15, 2020. The quality assessment tool QUADAS-2 was used to stratify studies according to their risk of bias, and exclusion criteria included not providing the information deemed relevant for such a stratification, such as not indicating if the patients were symptomatic or asymptomatic, or identifying the source of the specimen for the reference standard, RT-PCR (eg, nasal, oropharyngeal, etc). Sensitivity values were then extracted, and random effects meta-analyses were performed. Results: Of 641 search results, 37 studies (n = 9610 patients) were included in the analysis. The mean sensitivity of RT-PCR for COVID-19 reported by the biased studies was 70% (n = 5409/7 studies; 95% confidence interval [CI], 43-97; I 2 = 99.1%), compared with 78% by unbiased studies (n = 534/4 studies; 95% CI, 69-87, I 2 = 89.9%). For chest CT, the mean sensitivity reported by biased studies was 94% (n = 3371 patients/24 studies; 95% CI, 92-96; I 2 = 93.1%), compared with 75% by unbiased studies (n = 957/10 studies; 95% CI, 67-83; I 2 = 89.5%). Conclusions: The difference between the sensitivities of CT and RT-PCR for severe acute respiratory syndrome coronavirus-2 infection is lower than previously thought, as after stratifying the studies, the true sensitivity for CT based on the unbiased studies is limited.
Congenital gallbladder duplication, an uncommon but potentially complicating malformation, is rarely diagnosed preoperatively. A case in which the diagnosis was achieved by real-time ultrasonography is presented and correlated with hepatobiliary scintigraphy. The efficacy of these diagnostic modalities is discussed, and the available literature is reviewed.
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