Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to ...investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK.
We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case–fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models.
319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case–fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40–49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio OR 1·57, 95% CI 1·15–2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case–fatality rate (2·25, 1·13–4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09–4·08; p=0·028).
Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk–benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies.
University of Birmingham and University of Oxford.
Summary
Patients with haematological malignancies have a high risk of severe infection and death from SARS‐CoV‐2. In this prospective observational study, we investigated the impact of cancer type, ...disease activity, and treatment in 877 unvaccinated UK patients with SARS‐CoV‐2 infection and active haematological cancer. The primary end‐point was all‐cause mortality. In a multivariate analysis adjusted for age, sex and comorbidities, the highest mortality was in patients with acute leukaemia odds ratio (OR) = 1·73, 95% confidence interval (CI) 1·1–2·72, P = 0·017 and myeloma (OR 1·3, 95% CI 0·96–1·76, P = 0·08). Having uncontrolled cancer (newly diagnosed awaiting treatment as well as relapsed or progressive disease) was associated with increased mortality risk (OR = 2·45, 95% CI 1·09–5·5, P = 0·03), as was receiving second or beyond line of treatment (OR = 1·7, 95% CI 1·08–2·67, P = 0·023). We found no association between recent cytotoxic chemotherapy or anti‐CD19/anti‐CD20 treatment and increased risk of death within the limitations of the cohort size. Therefore, disease control is an important factor predicting mortality in the context of SARS‐CoV‐2 infection alongside the possible risks of therapies such as cytotoxic treatment or anti‐CD19/anti‐CD20 treatments.
Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality.
To evaluate ...whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality.
The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis.
SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated.
The primary end point was all-cause mortality within the primary hospitalization.
Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19-related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86).
The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed.
Panography is a series of linked poems that develops a disjunctive narrative from a simple premise: it transplants the figure of Pan into the backwoods of contemporary northern Ontario, on the ...fringes of a rural community. This idea owes much to Knut Hamsun's novel Pan , which places a Pan-like protagonist on the outskirts of a Norwegian village. Unlike Hamsun's Pan, Panography overtly acknowledges Pan's multiplicity as a cultural figure by juxtaposing its own Pan-narrative with nods to (and appropriations of) his appearances in classical mythology and literary iconography, and his rare invocations in contemporary popular culture. Panography is an examination of rural Canadian ideas of masculinity, an exploration of the backwoods story as social cement, a love poem to the details of the northern Ontario landscape, and a vaguely Jungian study of what happens when psychology embraces the natural world as its substrate (claiming that, despite cosmopolitan postmodernity, this is still possible). Panography is neither transcendentalist nor environmentalist in its primary agenda. Pan, as a hybrid of the human and the bestial, and as an archetype that has been carried to the present exclusively through artistic and scholarly works, is an ideal nexus for a deconstruction (or even a synthesis) of the received binary of art and nature. Panography allows its readers to escape the filtered aesthetic of much literary nature writing, in which the process of artistic representation places nature itself in a subordinate position, fit merely for terror, sentimentality or pathetic fallacy.
Just before his trip begins, however, the Driver meets Marie, a French woman of his own age who manages an itinerant troupe of acrobats and musicians. The Driver is quietly smitten by Marie, and, ...happily, her group intends to spend the subsequent weeks touring the Driver's usual haunts. Their travels frequently coincide, and Marie often opts to leave her troupe's school bus and travel in the Driver's bookmobile. The relationship develops slowly, for Jacques Poulin's characters are reserved types who shy away from aggressive romance or unprompted self-revelation. Marie and the Driver talk about their favourite books, the beauty of Quebec's landscape, and, with great reticence, about the terrors of aging. On their travels they encounter a host of rural readers who eagerly accept the Driver's books--and even the rejected, unpublished manuscripts that the Driver circulates as a service to Quebec's less successful writers. They also enjoy a couple of meetings with Jack, a kind of author's stand-in who makes rumbustious pronouncements on matters of literary taste and is overjoyed about Le Devoir's comment that " 'In book after book ... he gives us the same character with the same character traits.' " Jack also provides Poulin's readers with a brief list of their author's literary touchstones: Raymond Carver, Ernest Hemingway, John Fante, Gabrielle Roy, Boris Vian, Jack Kerouac, Richard Ford. Poulin's own style owes much to all of these writers, and as such is ideally suited to his emotive Quebecois road tales.
The greatest problem with Necessary Betrayals is Vigneault's occasional weakness for overwrought symbolism. Jack's old career as a bush pilot is an aspect of his character that seems contrived, as ...though it were grafted on to allow for a couple of key moments of pathos. Vigneault goes to great lengths to set up the flight of an airplane as an extended metaphor for the life and death of a relationship. Jack is able to pinpoint the precise moment at which his marriage to Monica ends: it is a day on which he tries to take her up for a flight in his Cessna, to see their newly renovated home from the air. Their plane runs into engine trouble and crashes on take-off, crashing into the row of trees at the end of the runway. Neither Jack nor Monica is permanently injured, but a drop of blood between Monica's thighs turns into a substantial hemorrhage, and the local doctors predict that she will never be able to have children again. The crash itself is attributed to impurities in the fuel, impurities that are due to Jack's flagrant neglect of his aircraft and the consequent corrosion of its fuel tank. The metaphor is a neat one but over-sentimentalized, which makes it rather difficult to stomach, especially when it is revisited at the very end of the novel. Vigneault's narrator is Jacques "Jack" Dubois, a professional photographer and former bush pilot who is just entering middle age. He is divorced, has few friends, and lives a life of intense boredom, shuffling back and forth between a cottage at La Minerve in backwoods Quebec, Val d'Or, and Montreal. On a whim, Jack decides to spring Tristan Molinari, the twentysomething brother of Monica, his ex-wife, from a psychiatric hospital. Tristan is an interesting sort--he is an undereducated math prodigy, a stock-market whiz, and a violent manic depressive. Together they head to Jack's cabin, where they receive a telephone call from Monica's mother, informing them that her daughter is pregnant. Jack is devastated by the news; Tristan suggests that they take Jack's old Buick and go on a road trip.
Farewell to one of the greatest captains in England's Test history Trades, Ray Illingworth Was A Jack Of All; Yorkshire, A Master Of Many. Cricket Writer Chris Waters Pays Tribute To One Of; Sons., England'S Finest
The Yorkshire post (Leeds, England : 1959),
12/2021
Newspaper Article
Aims and Objectives To explore student nurse and educator perspectives on the use of poetry writing as a way to reflect on important nursing practice issues. Background Reflective practice is a ...well-established method of learning in pre-registration nurse education although student nurses can find reflection a challenging process. Design An exploratory descriptive approach. Methods Data were extracted from unstructured interviews with students and educators (n = 12) from one university in the North-West region of England, United Kingdom (UK). Data were thematically analysed. Results Poetry writing supports a meaningful exploration of events, which have the potential to lead to changes in perspective. Careful planning of the poetry writing process is required, to ensure the potential of this approach is realised. Conclusion Poetry writing is an effective way to reflect on clinical practice. This work has relevance and transferability to a wide range of professional disciplines, where reflective practice is encouraged.
PDF
