Covid-19-related cervical cancer treatment interruption and role of neoadjuvant chemotherapy

Covid-19相关的宫颈癌治疗中断和新辅助化疗的作用

• 批准号: 10381101
• 负责人: Scott Dryden-Peterson
• 金额: $ 13.6万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10381101
• 关键词: Acquired Immunodeficiency Syndrome; Adverse effects; Affect; Africa; Biopsy; Botswana; COVID-19; COVID-19 pandemic; Cancer Control; Cancer Etiology; Carboplatin; Caring; Cause of Death; Cessation of life; Chemotherapy and/or radiation; Clinical; Collaborations; Complex; Conflict (Psychology); Country; Data; Diagnosis; Diagnostic; Disease; Endoscopes; Engineering; Epidemic; Equipment; Evolution; Failure; Funding; Future; Goals; HIV; Health system; Image; Immunohistochemistry; Infrastructure; Institutes; Interruption; Intervention; Linear Accelerator Radiotherapy Systems; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Medical; Methods; Natural experiment; Neoadjuvant Therapy; Oncology; Operative Surgical Procedures; Outcome; Paclitaxel; Participant; Pathology; Patients; Politics; Pregnancy; Process; Public Health; Radiation; Radiation therapy; Reagent; Research Personnel; Resources; Role; SARS-CoV-2 infection; Services; Shock; Southern Africa; System; Time; Universities; Woman; base; cancer care; cancer therapy; care delivery; case history; chemoradiation; chemotherapy; cohort; curative treatments; experience; improved; interest; multidisciplinary; pandemic disease; preservation; prevent; prospective; repaired; response; symptom treatment; tissue processing; treatment duration; tumor; tumor progression

Project Summary/Abstract This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT- CA-21-033. Curative therapy for locally advanced cervical cancer, the leading cause of cancer death in southern Africa, requires chemoradiation. In nearly all countries in southern Africa, including Botswana, radiotherapy is only available from a single center, creating substantial vulnerability. Similar to several other countries, the radiotherapy unit in Botswana experienced prolonged downtimes due to Covid-19-related border restrictions preventing routine service and repair. The clinical impact of delayed treatment of cervical cancer is poorly understood and the use of `temporizing' chemotherapy to mitigate adverse effects of delays is sparsely studied. With the goal of informing resilient and ready mitigation strategies for periods of epidemic, armed conflict, political uprising, and environmental crises we utilize prospective data collected in the Thabatse cancer cohort (2010 to present, n=4950) to estimate the duration of treatment delay associated with cervical cancer stage progression and whether neoadjuvant therapy may preserve the option for curative therapy during periods of prolonged health system disruption. Analyses will utilize the instrumental variable methods and two natural experiments: unexpected loss of radiation therapy in Botswana (current Covid-19 pandemic and two prior periods) and the decision by Botswana clinicians to provide `temporizing' chemotherapy during lack of access to radiation.

项目摘要/摘要 本申请是为回应特别利益通知(NOSI)而提出的，该通知被确认为非- CA-21-033。 当地晚期宫颈癌的根治疗法，这是南部非洲癌症死亡的主要原因， 需要化疗和放射治疗。在南部非洲的几乎所有国家，包括博茨瓦纳，放射治疗是 只能从一个中心获得，这造成了严重的漏洞。与其他几个国家类似， 博茨瓦纳放射治疗单元因新冠肺炎相关边界而停机时间延长 妨碍日常服务和维修的限制。宫颈癌延期治疗对临床的影响 人们对此知之甚少，而使用“暂时性”化疗来减轻延误的不良影响是 很少有人研究。目标是为以下时期提供有弹性的、随时可用的缓解战略 流行病、武装冲突、政治起义和环境危机，我们利用在 塔巴塞癌症队列(2010年至今，n=4950)估计治疗延迟的持续时间 与宫颈癌分期进展相关以及新辅助治疗是否可以保留这一选择 用于在长期卫生系统中断期间进行治疗。分析将利用 工具变量方法和两个自然实验：放射治疗的意外损失 博茨瓦纳(目前的新冠肺炎大流行和之前的两个时期)以及博茨瓦纳临床医生决定 在无法获得辐射的情况下提供“暂时性”化疗。