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 该申请是根据特殊利益通知（NOSI）提交的 CA-21-033。 治疗局部晚期宫颈癌的治疗疗法，这是南部非洲癌症死亡的主要原因， 需要化学放疗。在包括博茨瓦纳在内的南部非洲几乎所有国家，放疗是 仅从一个中心可用，创造了实质性漏洞。与其他几个国家类似 博茨瓦纳的放射疗法单元由于19与19与19的边界有关 防止常规服务和维修的限制。宫颈癌延迟治疗的临床影响 知之甚少，并且使用“临时”化学疗法来减轻延迟的不良影响是 稀疏研究。目的是告知有关时期的弹性和现成缓解策略 流行病，武装冲突，政治起义和环境危机我们利用了预期数据 Thabatse Cancer Cohort（2010年，n = 4950）以估计治疗延迟的持续时间 与宫颈癌阶段进展以及新辅助治疗相关 长期卫生系统中断期间的治疗疗法。分析将利用 仪器可变方法和两个自然实验：在 博茨瓦纳（当前的Covid-19大流行和两个先前时期），博茨瓦纳临床医生决定 在无法获得辐射的过程中提供“临时”化疗。