News Scan for Sep 09, 2021

COVID-19 and colorectal cancer
COVID vaccines and mental health

Colorectal cancer patients fared worse after COVID lockdowns, study finds

Patients diagnosed as having metastatic colorectal cancer (mCRC) after COVID-19 lockdowns in France had significantly higher tumor burdens and died sooner than those diagnosed before the pandemic, shows a multicenter study yesterday in JAMA Network Open.

In the study, a team led by researchers at the Universite de Montpellier evaluated the tumor burden of 80 patients at 18 centers with mCRC using circulating tumor DNA (ctDNA) in plasma, which the authors said rises with increasing tumor size. The patients (median age, 62 years) were enrolled in a phase 2 clinical trial comparing the activity of two drug combinations.

The 40 patients diagnosed after the spring 2020 lockdowns (May 14 to Sep 3, 2020) had median ctDNA concentrations of 119.2 nanograms per milliliter (ng/mL), compared with 17.3 ng/mL in the 40 patients screened before (Nov 11, 2019, to Mar 9, 2020). The post-lockdown ctDNA level constituted a 6.9-fold increase.

Patients with greater tumor burden also had significantly lower median survival than those with lesser tumor burden (14.7 months vs 20.0 months; hazard ratio, 1.74).

The researchers noted that the pandemic has been tied to large reductions and delays in screening, diagnosis, and hospital referrals for cancer patients, while the reprioritization of hospital staff and resources to COVID-19 patients has been linked to delayed or compromised care.

"The differences in tumor burden between patients who were diagnosed before vs after lockdown and the resulting risk of reduced survival point to the association between the pandemic-related lockdown and unfavorable consequences for patients with newly diagnosed mCRC, who may have delayed their first visit to an oncologist," the authors wrote. They added that patients may have been reluctant to visit a healthcare facility because of fears of COVID-19 infection or burdening the health system.

To prepare for any further coronavirus-related lockdowns, the researchers called for reinforced mass CRC screening using fecal occult blood testing, communicating the urgency of screening to patients, and providing adequate resources and planning to manage backlogs in diagnosis and treatment. "The findings of this study suggest that CRC is a major area for intervention to minimize pandemic-associated delays in screening, diagnosis, and treatment," they wrote.
Sep 8 JAMA Netw Open study


Mental health improved somewhat after COVID vaccine, poll says

People who received at least one COVID-19 vaccination between December 2020 and March 2021 were a bit more likely to report lower mental distress levels, according to a study yesterday in PLOS One.

The researchers used the representative Understanding America Study cohort, and from Mar 10, 2020, to Mar 31, 2021, 8,003 adults answered at least 2 of the 26 surveys (average response rate per survey, 82%), which were conducted from weekly to monthly.

People who reported receiving at least one COVID-19 vaccination had a 1-percentage-point drop in mild depression probability and a 0.7-percentage-point drop in severe depression probability, a relative reduction of 4% and 15%, respectively. Overall, the results showed an average effect comparative to 4% of the standard deviation of PHQ-4 scores, or the four-item Patient Health Questionnaire that made up the framework of the survey.

Vaccinated respondents were more likely to be older (average age, 60.4 vs 47.1 years), college educated (68% vs 52%), and White (87% vs 82%).

"Those recently vaccinated may become less worried about getting infected, they may become more active socially, or they may venture into different work opportunities," the researchers write.

They add, however, "Since people who get the vaccines at different times are different in several dimensions, this implies that the effects may be different for the people who get vaccinated after the period studied here. Another reason why the effects may be different in a later period is that the conditions may be different."
Sep 8 PLOS One study

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