Administrative Core

新冠肺炎大流行和随之而来的美国封锁迫使癌症患者护理发生了突然和计划外的变化。大多数癌症患者在接受治疗时年龄较大，免疫功能低下，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好的护理，同时最大限度地降低感染SARS-CoV-2的风险。同时，患者坚持治疗建议的能力，以及应对癌症治疗引起的副作用和各种合并症的能力也受到COVID-19大流行后果的严重影响。许多患者失去了通常处理护理的基础设施，许多患者可能由于恐惧、缺乏资源或经济不稳定而改变了他们对治疗的行为。由于covid - 19，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的变化的总体影响尚未确定。美国癌症协会癌症行动网络（American Cancer Society Cancer Action Network）的早期数据显示，在接受积极治疗的癌症患者中，近80%的人在接受医疗保健治疗时出现了延误，其中17%的人报告说他们接受了癌症治疗。我们建议评估COVID-19大流行对不同人群癌症护理服务的影响，特别是受本次疫情影响最大的人群，包括黑人和西班牙裔。我们建议确定和评估癌症治疗中持续变化的影响，以及不同人群中患者对治疗依从性的变化，其长期目标是从这一经验中学习，以便在这种大流行继续发展的过程中更好地为癌症患者提供服务。大流行迫使对癌症治疗方案和幸存者随访进行修改，以适应居家要求、新的医院规程以降低感染率和保护脆弱的癌症患者。这些改变中的许多可能被证明与标准护理一样有效，有些可能没有。我们建议在诺里斯综合癌症中心（NCCC）诊所开展一项混合方法研究，重点关注我们诊所数量较多的集水区的两种优先癌症：乳腺癌（BrCa）和肺癌（LCa），重点确定从2020年3月COVID-19大流行开始到2020年9月，与2019年同期相比，这两种癌症的癌症治疗变化（目标1）。我们建议确定治疗变化并评估其对治疗后12个月短期结果的影响。考虑到我们患者群体的多样性，我们在确定少数群体癌症治疗结果和治疗依从性方面具有独特的优势，特别是占我们患者群体约40%的西班牙裔患者。为了加强我们对COVID-19在黑人癌症患者中的影响的了解和理解，我们正在利用佛罗里达-加利福尼亚癌症研究教育和参与（CaRE2）健康公平中心社区外展核心，该核心侧重于佛罗里达州和加利福尼亚州黑人和西班牙裔人的社区外展和参与，并将使我们能够纳入大量黑人患者群体。

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.