Administrative Core

新冠肺炎疫情和随之而来的全美封锁迫使癌症患者护理方面发生了突然的、计划外的变化。大多数癌症患者年龄较大，在接受治疗时免疫功能受损，这对肿瘤学家和外科医生来说是一个艰巨的挑战，他们试图决定如何继续为患者提供最佳护理，同时将感染SARS-CoV-2的风险降至最低。与此同时，患者遵守治疗建议的能力，以及应对癌症治疗引发的副作用和各种并存疾病的能力，也受到了新冠肺炎大流行后果的严重影响。许多患者失去了他们通常的基础设施来处理他们的护理，许多人可能因为恐惧、缺乏资源或经济不稳定而改变了他们对治疗的行为。癌症治疗模式的持续变化以及患者对正在进行的治疗的依从性因COVID19而发生的变化的总体影响尚未确定。来自美国癌症协会癌症行动网络的早期数据显示，在积极治疗癌症的患者中，近80%的患者经历了医疗保健延迟，其中17%的患者报告了他们的癌症治疗。我们建议评估新冠肺炎大流行对不同人群提供癌症护理服务的影响，特别是那些受此次疫情影响最大的人群，其中包括黑人和拉美裔美国人。我们建议确定和评估癌症治疗中正在发生的变化以及不同人群中患者对治疗依从性的变化所产生的影响，长期目标是从这一经验中学习，以更好地服务于随着这场大流行继续发展的癌症患者。这场大流行迫使癌症治疗方案和生存后续行动发生变化，以适应呆在家里的要求，为降低感染率和保护脆弱的癌症患者而制定新的医院方案。这些变化中的许多可能会被证明与护理标准一样有效，但有些可能不是。我们建议在诺里斯综合癌症中心的诊所内进行一项混合方法研究，重点关注我们诊所数量最多的两种集水区癌症：乳腺癌和肺癌，重点是确定从2020年3月新冠肺炎大流行开始到2020年9月这两种癌症的癌症治疗与2019年同期相比的变化(目标1)。我们建议在治疗12个月后确定治疗变化并评估其对短期结果的影响。鉴于我们患者群体的多样性，我们处于独特的地位，可以确定少数族裔人群在癌症治疗结果和坚持治疗方面的差异，特别是占我们患者群体约40%的拉美裔美国人。为了加强我们在黑人癌症患者中对新冠肺炎影响的接触和了解，我们正在利用佛罗里达-加州癌症研究教育和参与(CARE2)健康公平中心社区外联核心，该中心专注于佛罗里达州和加利福尼亚州黑人和拉美裔美国人的社区外联和参与，将使我们能够包括大量黑人患者。

The COVID-19 pandemic and concomitant lockdown across the US has forced sudden and unplanned changes in cancer patient care. A majority of cancer patients are older and immunocompromised while undergoing treatment, which presents a difficult challenge for oncologists and surgeons trying to decide how to continue the best care for their patients while minimizing the risk of infection with SARS-CoV-2. Simultaneously, the ability of patients to adhere to treatment recommendations, and to deal with cancer treatment induced side effects and various co-morbidities, has also been severely affected by the consequences of the COVID-19 pandemic. Many patients lost their usual infrastructure to handle their care, and many may have altered their behaviors towards treatment due to fear, lack of resources, or financial instability. The overall impact of ongoing changes in cancer treatment patterns, and changes in patient adherence to ongoing treatment due to COVID19 is yet to be defined. Early numbers from the American Cancer Society Cancer Action Network show that close to 80% of patients in active treatment for cancer experienced a delay in their healthcare, including 17% that reported to their cancer therapy. We propose to evaluate the impact of the COVID-19 pandemic on cancer care delivery among diverse populations, particularly those mostly affected by this outbreak, which include Blacks and Hispanics. We propose to identify and evaluate the impact of ongoing changes in cancer treatment, and changes in patient adherence to treatment among diverse populations, with the long-term goal of learning from this experience to better serve cancer patients moving forward as this pandemic continues its course. The pandemic imposed changes in cancer treatment protocols and survivorship follow-up to accommodate stay-at-home requirements, new hospital protocols to reduce infection rates, and for the protection of vulnerable cancer patients. Many of these changes may prove to be as effective as the standard of care, some may not. We propose to conduct a mixed-methods study within the Norris Comprehensive Cancer Center (NCCC) clinics, focusing on two of the priority cancers for our catchment area with high volume in our clinics: breast (BrCa) and lung cancer (LCa), focusing on identifying changes in cancer treatment for these two cancers from the start of the COVID-19 pandemic in March 2020 until September 2020, in comparison with the same time period in 2019 (Aim 1). We propose to identify treatment changes and evaluate their impact on short-term outcomes 12 months post-treatment. Given the diversity of our patient population, we are uniquely positioned to identify disparities in cancer treatment outcomes and adherence to treatment among minority populations, particularly Hispanics who constitute ~40% of our patient population. To enhance our reach and understanding of the impact of COVID-19 among Black cancer patients, we are leveraging the Florida-California Cancer Research Education and Engagement (CaRE2) Health Equity Center Community Outreach Core, which is focused on community outreach and engagement among Blacks and Hispanics in Florida and California, and will allow us to include a large Black patient population.