Background
The COVID‐19 outbreak has resulted in collision between patients infected with SARS‐CoV‐2 and those with cancer on different fronts. Patients with cancer have been impacted by deferral, ...modification, and even cessation of therapy. Adaptive measures to minimize hospital exposure, following the precautionary principle, have been proposed for cancer care during COVID‐19 era. We present here a consensus on prioritizing recommendations across the continuum of sarcoma patient care.
Material and Methods
A total of 125 recommendations were proposed in soft‐tissue, bone, and visceral sarcoma care. Recommendations were assigned as higher or lower priority if they cannot or can be postponed at least 2–3 months, respectively. The consensus level for each recommendation was classified as “strongly recommended” (SR) if more than 90% of experts agreed, “recommended” (R) if 75%–90% of experts agreed and “no consensus” (NC) if fewer than 75% agreed. Sarcoma experts from 11 countries within the Sarcoma European‐Latin American Network (SELNET) consortium participated, including countries in the Americas and Europe. The European Society for Medical Oncology‐Magnitude of clinical benefit scale was applied to systemic‐treatment recommendations to support prioritization.
Results
There were 80 SRs, 35 Rs, and 10 NCs among the 125 recommendations issued and completed by 31 multidisciplinary sarcoma experts. The consensus was higher among the 75 higher‐priority recommendations (85%, 12%, and 3% for SR, R, and NC, respectively) than in the 50 lower‐priority recommendations (32%, 52%, and 16% for SR, R, and NC, respectively).
Conclusion
The consensus on 115 of 125 recommendations indicates a high‐level of convergence among experts. The SELNET consensus provides a tool for sarcoma multidisciplinary treatment committees during the COVID‐19 outbreak.
Implications for Practice
The Sarcoma European‐Latin American Network (SELNET) consensus on sarcoma prioritization care during the COVID‐19 era issued 125 pragmatical recommendations distributed as higher or lower priority to protect critical decisions on sarcoma care during the COVID‐19 pandemic. A multidisciplinary team from 11 countries reached consensus on 115 recommendations. The consensus was lower among lower‐priority recommendations, which shows reticence to postpone actions even in indolent tumors. The European Society for Medical Oncology‐Magnitude of Clinical Benefit scale was applied as support for prioritizing systemic treatment. Consensus on 115 of 125 recommendations indicates a high level of convergence among experts. The SELNET consensus provides a practice tool for guidance in the decisions of sarcoma multidisciplinary treatment committees during the COVID‐19 outbreak.
The COVID‐19 pandemic has caused deferral, modification, or cessation of treatment for patients with cancer. This article presents a consensus on prioritizing recommendations across the continuum of sarcoma patient care.
Se presenta el caso de un paciente de 21 años, con historia de 3 episodios de meningitis bacteriana por cocos grampositivos (CGP) en los últimos dos años, sin antecedente de trauma craneoencefálico ...ni inmunodeficiencia conocida. Se realizó el abordaje diagnóstico, descartando un síndrome de inmunodeficiencia; con base en estudios de imagen como cisternografía se documentó una fístula de LCR en la base del cráneo, en la región petrosa mastoidea izquierda hacia los músculos cervicales ipsilaterales
La púrpura fulminante (PF) es una manifestación inusual en la piel asociada a Coagulación Intravascular Diseminada (CID) secundaria generalmente a infección o sepsis caracterizada por necrosis de la ...piel, por trombosis de vasos pequeños. Es una patología grave, de inicio agudo, con rápida progresión y alta morbimortalidad.( 1) Se presenta el caso de un paciente masculino de 34 años de edad, con antecedente de esplenectomía por traumatismo abdominal a los 10 años de edad, sin terapia antimicrobiana profiláctica ni vacunación antineumocócica previa, que consultó por 24 horas de evolución de cefalea generalizada, malestar general, dolor en ambos miembros inferiores y rash equimótico en la piel, el cual posteriormente presentó avance de las lesiones necróticas y choque séptico. Los laboratorios iniciales fueron compatibles con CID. Los hemocultivos y el cultivo de líquido cefalorraquídeo fueron positivos por Streptococcus pneumonie.
La acidosis láctica es una complicación pocofrecuente de las neoplasias malignas, que fuedescrita por primera vez en pacientes con leucemia aguda en 1963. Desde entonces, se ha observado más a ...menudo, en particular en neoplasias hematológicas y rara vez en los tumoressólidos. Presentamos el caso de un hombre de 53 años con lactacidosis tipo B1 y linfoma de Burkitt gástrico, quien fue admitido al hospital consíntomas constitucionales, pérdida de peso, diarrea y melena. Los gases arteriales revelaron unaacidosis metabólica con brecha aniónica aumentada (pH 7,278; HCO3- 9,1 mmol/l, brecha aniónica 20) y concentración elevada de lactato (15,5mmol/l). Se descartó causas de lactacidosis tipo A como insuficiencia circulatoria, sepsis y choque. También se descartó causas comunes deacidosis láctica tipo B, como infecciones, diabetes mellitus, falla renal, insuficiencia hepática,déficit de tiamina, fármacos y toxinas.
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