In recent years the terms time and financial toxicities have entered the vocabulary of cancer care. We would like to introduce another toxicity: climate toxicity. Climate toxicity is a double-edge ...sword in cancer care. Increasing cancer risk by exposure to carcinogens, and consequently increasing treatment requirements leads to ever growing damage to our environment. This article assesses the impact of climate change on patients, the climate toxicity caused by both healthcare workers and healthcare facilities, and suggests actions that may be taken mitigate them.
Abstract Background Climate change is a threat to human health; equally health care is a threat to climate change as it accounts for 4% of greenhouse gas emissions and 30% of the world’s ...electronically stored data. 350,000 international trials are registered on ClinicalTrials.gov with ~27·5 million tonnes of emissions (equivalent to half of annual Danish emissions). Methods In September 2023 climate awareness among cancer clinical trial organisations was assessed via a web-based scoping exercise. Results Seventy-five organisations were identified of whom 46 had search tools on their websites. Eight out of 46 clinical trial groups had at least one parameter of commitment to climate change, and 38 organisations had none. Of 46 websites, 5 had climate change position statements or policies, 4 had a committee or task force, 1 provided patient education resources for climate change via video link, 7 included green initiative advice and 8 had publications addressing climate change. Only 5 were listed as members of Climate Change Consortiums. Conclusions Based on website assessment climate advocacy among cancer clinical trial organisations is low, and efforts to encourage climate engagement are needed.
Abstract
Background
The aims of this study were to explore the impact of COVID-19 on health-care services and quality of life (QoL) in women diagnosed with breast cancer (BC) in Ireland and whether ...the impact varied by social determinants of health (SDH).
Methods
Women diagnosed with BC completed a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during COVID-19 restrictions. The association between COVID-19 impact and disruption to BC services and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within the regression models.
Results
A total of 30.5% (n = 109) of women reported high COVID-19 impact, and these women experienced more disruption in BC services (odds ratio = 4.95, 95% confidence interval = 2.28 to 10.7, P < .001) and lower QoL (β = −12.01, SE = 3.37, P < .001) compared with women who reported low COVID-19 impact. Health insurance status moderated the effect of COVID-19 on disruption to BC services and QoL. Women who reported high COVID-19 impact experienced more disruption to BC services and lower QoL compared with women with low COVID-19 impact; however, the magnitude of these unfavorable effects differed by insurance status (Pinteraction < .05).
Conclusions
There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact was not the same for all women. It is important that women with BC are reintegrated into proper care and QoL is addressed through multidisciplinary support services.
Background: Bone modifying agents are used throughout cancer care and their utilisation can optimise advanced stage cancer cases with bone metastases, by reducing skeletal-related events, ...treatment-induced bone loss and treatment hypercalcaemia. They are also used in patients with a curative intent such as early breast cancer, reducing recurrence and increasing survival rates. Medication-related osteonecrosis of the jaw (MRONJ) is a potential complication following bone modifying agents (BMAs). It represents exposed bone in the maxillofacial region which significantly compromises the quality of life for these patients. Dental disease is the most common initiating factor of MRONJ. We report a case in which MRONJ has dominated cancer care despite its successful treatment.
Case presentation: A 69-year-old female was diagnosed with a breast cancer (grade 1, infiltrating ductal carcinoma, pT1c pN1mi(sc) Mx), for which she was treated with a wide local excision and axillary lymph-node clearance. Seven years after initial presentation, the patient presented with metastatic disease involving the left supraclavicular fossa, bone, peritoneum, and liver. Her BMA regime included zoledronic acid intravenous (IV) every month for 12 months and switched to oral zoledronic acid for a subsequent year due to poor venous access.
Two years after her diagnosis of metastatic disease, the patient presented with exposed bone in her anterior maxilla, which represented advanced stage MRONJ (AAOMS 3). The exposed bone in the maxilla was treated surgically by sequestrectomy and fistula closure. Three years later (12 years after initial breast cancer diagnosis), the patient was re-admitted with a cervical fascial space infection involving the right mandible. The patient developed another site of advanced- stage MRONJ (AAOMS 3) in the right mandible associated with an orocutaneous fistula. The patient had a marginal resection of her mandible, fistula closure and extraction of the remaining teeth under general anesthetic.
Conclusion: The practicing oncologist needs to be cognisant of the possibility of MRONJ in both the curative and palliative setting. Traditionally, oncology care has required a significant degree of self-reliance on patients to navigate dental treatment pathways. Integration of dental clinics into oncology pathways would help eliminate this need for self-reliance. MRONJ is an inevitable risk for a large cohort of oncology patients and active engagement of dental-oncology specialities will ensure optimal care for patients.
