PMC:7529504 / 14621-21916 JSONTXT

{"project":"LitCovid-PD-FMA-UBERON","denotations":[{"id":"T2","span":{"begin":1349,"end":1353},"obj":"Body_part"}],"attributes":[{"id":"A2","pred":"fma_id","subj":"T2","obj":"http://purl.org/sig/ont/fma/fma9712"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"LitCovid-PD-UBERON","denotations":[{"id":"T4","span":{"begin":1349,"end":1353},"obj":"Body_part"},{"id":"T5","span":{"begin":6881,"end":6886},"obj":"Body_part"}],"attributes":[{"id":"A4","pred":"uberon_id","subj":"T4","obj":"http://purl.obolibrary.org/obo/UBERON_0002398"},{"id":"A5","pred":"uberon_id","subj":"T5","obj":"http://purl.obolibrary.org/obo/UBERON_0002542"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"LitCovid-PD-MONDO","denotations":[{"id":"T63","span":{"begin":65,"end":73},"obj":"Disease"},{"id":"T64","span":{"begin":86,"end":92},"obj":"Disease"},{"id":"T65","span":{"begin":556,"end":562},"obj":"Disease"},{"id":"T66","span":{"begin":806,"end":816},"obj":"Disease"},{"id":"T67","span":{"begin":872,"end":905},"obj":"Disease"},{"id":"T68","span":{"begin":1114,"end":1120},"obj":"Disease"},{"id":"T69","span":{"begin":1824,"end":1833},"obj":"Disease"},{"id":"T70","span":{"begin":1970,"end":1979},"obj":"Disease"},{"id":"T71","span":{"begin":2367,"end":2373},"obj":"Disease"},{"id":"T72","span":{"begin":2437,"end":2443},"obj":"Disease"},{"id":"T73","span":{"begin":2783,"end":2789},"obj":"Disease"},{"id":"T74","span":{"begin":3194,"end":3200},"obj":"Disease"},{"id":"T75","span":{"begin":3299,"end":3305},"obj":"Disease"},{"id":"T76","span":{"begin":3323,"end":3329},"obj":"Disease"},{"id":"T77","span":{"begin":3852,"end":3858},"obj":"Disease"},{"id":"T78","span":{"begin":3975,"end":3981},"obj":"Disease"},{"id":"T79","span":{"begin":6418,"end":6424},"obj":"Disease"},{"id":"T80","span":{"begin":6542,"end":6548},"obj":"Disease"},{"id":"T81","span":{"begin":6908,"end":6914},"obj":"Disease"},{"id":"T82","span":{"begin":7011,"end":7017},"obj":"Disease"}],"attributes":[{"id":"A63","pred":"mondo_id","subj":"T63","obj":"http://purl.obolibrary.org/obo/MONDO_0100096"},{"id":"A64","pred":"mondo_id","subj":"T64","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A65","pred":"mondo_id","subj":"T65","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A66","pred":"mondo_id","subj":"T66","obj":"http://purl.obolibrary.org/obo/MONDO_0005550"},{"id":"A67","pred":"mondo_id","subj":"T67","obj":"http://purl.obolibrary.org/obo/MONDO_0005091"},{"id":"A68","pred":"mondo_id","subj":"T68","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A69","pred":"mondo_id","subj":"T69","obj":"http://purl.obolibrary.org/obo/MONDO_0005550"},{"id":"A70","pred":"mondo_id","subj":"T70","obj":"http://purl.obolibrary.org/obo/MONDO_0005550"},{"id":"A71","pred":"mondo_id","subj":"T71","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A72","pred":"mondo_id","subj":"T72","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A73","pred":"mondo_id","subj":"T73","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A74","pred":"mondo_id","subj":"T74","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A75","pred":"mondo_id","subj":"T75","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A76","pred":"mondo_id","subj":"T76","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A77","pred":"mondo_id","subj":"T77","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A78","pred":"mondo_id","subj":"T78","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A79","pred":"mondo_id","subj":"T79","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A80","pred":"mondo_id","subj":"T80","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A81","pred":"mondo_id","subj":"T81","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"},{"id":"A82","pred":"mondo_id","subj":"T82","obj":"http://purl.obolibrary.org/obo/MONDO_0004992"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"LitCovid-PD-CLO","denotations":[{"id":"T60","span":{"begin":133,"end":138},"obj":"http://purl.obolibrary.org/obo/UBERON_0001456"},{"id":"T61","span":{"begin":353,"end":354},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T62","span":{"begin":1893,"end":1894},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T63","span":{"begin":2114,"end":2115},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T64","span":{"begin":2199,"end":2201},"obj":"http://purl.obolibrary.org/obo/CLO_0050509"},{"id":"T65","span":{"begin":2239,"end":2240},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T66","span":{"begin":2276,"end":2288},"obj":"http://purl.obolibrary.org/obo/OBI_0000245"},{"id":"T67","span":{"begin":2680,"end":2681},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T68","span":{"begin":2712,"end":2713},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T69","span":{"begin":3679,"end":3680},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T70","span":{"begin":3867,"end":3868},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T71","span":{"begin":3900,"end":3901},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T72","span":{"begin":4220,"end":4221},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T73","span":{"begin":5009,"end":5010},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T74","span":{"begin":5214,"end":5219},"obj":"http://purl.obolibrary.org/obo/UBERON_0007688"},{"id":"T75","span":{"begin":5286,"end":5287},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T76","span":{"begin":5642,"end":5647},"obj":"http://purl.obolibrary.org/obo/UBERON_0000473"},{"id":"T77","span":{"begin":5661,"end":5662},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T78","span":{"begin":5795,"end":5802},"obj":"http://www.ebi.ac.uk/efo/EFO_0000881"},{"id":"T79","span":{"begin":6109,"end":6110},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T80","span":{"begin":6198,"end":6206},"obj":"http://purl.obolibrary.org/obo/CLO_0001658"},{"id":"T81","span":{"begin":6433,"end":6434},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T82","span":{"begin":6576,"end":6577},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T83","span":{"begin":6980,"end":6983},"obj":"http://purl.obolibrary.org/obo/PR_000001343"},{"id":"T84","span":{"begin":7128,"end":7129},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"LitCovid-PubTator","denotations":[{"id":"230","span":{"begin":65,"end":73},"obj":"Disease"},{"id":"231","span":{"begin":86,"end":92},"obj":"Disease"},{"id":"240","span":{"begin":389,"end":396},"obj":"Species"},{"id":"241","span":{"begin":542,"end":550},"obj":"Species"},{"id":"242","span":{"begin":1100,"end":1108},"obj":"Species"},{"id":"243","span":{"begin":1218,"end":1226},"obj":"Species"},{"id":"244","span":{"begin":556,"end":562},"obj":"Disease"},{"id":"245","span":{"begin":835,"end":867},"obj":"Disease"},{"id":"246","span":{"begin":872,"end":905},"obj":"Disease"},{"id":"247","span":{"begin":1114,"end":1120},"obj":"Disease"},{"id":"255","span":{"begin":1752,"end":1760},"obj":"Species"},{"id":"256","span":{"begin":1773,"end":1781},"obj":"Species"},{"id":"257","span":{"begin":1928,"end":1936},"obj":"Species"},{"id":"258","span":{"begin":2019,"end":2026},"obj":"Species"},{"id":"259","span":{"begin":1824,"end":1833},"obj":"Disease"},{"id":"260","span":{"begin":1835,"end":1854},"obj":"Disease"},{"id":"261","span":{"begin":1970,"end":1979},"obj":"Disease"},{"id":"265","span":{"begin":2353,"end":2361},"obj":"Species"},{"id":"266","span":{"begin":2367,"end":2373},"obj":"Disease"},{"id":"267","span":{"begin":2437,"end":2443},"obj":"Disease"},{"id":"278","span":{"begin":2727,"end":2739},"obj":"Species"},{"id":"279","span":{"begin":2769,"end":2777},"obj":"Species"},{"id":"280","span":{"begin":2871,"end":2879},"obj":"Species"},{"id":"281","span":{"begin":2958,"end":2965},"obj":"Species"},{"id":"282","span":{"begin":3285,"end":3293},"obj":"Species"},{"id":"283","span":{"begin":3452,"end":3460},"obj":"Species"},{"id":"284","span":{"begin":2783,"end":2789},"obj":"Disease"},{"id":"285","span":{"begin":3194,"end":3200},"obj":"Disease"},{"id":"286","span":{"begin":3299,"end":3305},"obj":"Disease"},{"id":"287","span":{"begin":3323,"end":3329},"obj":"Disease"},{"id":"290","span":{"begin":3852,"end":3858},"obj":"Disease"},{"id":"291","span":{"begin":3975,"end":3981},"obj":"Disease"},{"id":"293","span":{"begin":4113,"end":4120},"obj":"Species"},{"id":"295","span":{"begin":5604,"end":5611},"obj":"Species"},{"id":"297","span":{"begin":6275,"end":6292},"obj":"Disease"},{"id":"305","span":{"begin":6502,"end":6509},"obj":"Species"},{"id":"306","span":{"begin":6618,"end":6626},"obj":"Species"},{"id":"307","span":{"begin":6816,"end":6824},"obj":"Species"},{"id":"308","span":{"begin":6418,"end":6424},"obj":"Disease"},{"id":"309","span":{"begin":6542,"end":6548},"obj":"Disease"},{"id":"310","span":{"begin":6908,"end":6914},"obj":"Disease"},{"id":"311","span":{"begin":7011,"end":7017},"obj":"Disease"}],"attributes":[{"id":"A230","pred":"tao:has_database_id","subj":"230","obj":"MESH:C000657245"},{"id":"A231","pred":"tao:has_database_id","subj":"231","obj":"MESH:D009369"},{"id":"A240","pred":"tao:has_database_id","subj":"240","obj":"Tax:9606"},{"id":"A241","pred":"tao:has_database_id","subj":"241","obj":"Tax:9606"},{"id":"A242","pred":"tao:has_database_id","subj":"242","obj":"Tax:9606"},{"id":"A243","pred":"tao:has_database_id","subj":"243","obj":"Tax:9606"},{"id":"A244","pred":"tao:has_database_id","subj":"244","obj":"MESH:D009369"},{"id":"A245","pred":"tao:has_database_id","subj":"245","obj":"MESH:D018352"},{"id":"A246","pred":"tao:has_database_id","subj":"246","obj":"MESH:D045169"},{"id":"A247","pred":"tao:has_database_id","subj":"247","obj":"MESH:D009369"},{"id":"A255","pred":"tao:has_database_id","subj":"255","obj":"Tax:9606"},{"id":"A256","pred":"tao:has_database_id","subj":"256","obj":"Tax:9606"},{"id":"A257","pred":"tao:has_database_id","subj":"257","obj":"Tax:9606"},{"id":"A258","pred":"tao:has_database_id","subj":"258","obj":"Tax:9606"},{"id":"A259","pred":"tao:has_database_id","subj":"259","obj":"MESH:D007239"},{"id":"A260","pred":"tao:has_database_id","subj":"260","obj":"MESH:D030342"},{"id":"A261","pred":"tao:has_database_id","subj":"261","obj":"MESH:D007239"},{"id":"A265","pred":"tao:has_database_id","subj":"265","obj":"Tax:9606"},{"id":"A266","pred":"tao:has_database_id","subj":"266","obj":"MESH:D009369"},{"id":"A267","pred":"tao:has_database_id","subj":"267","obj":"MESH:D009369"},{"id":"A278","pred":"tao:has_database_id","subj":"278","obj":"Tax:9606"},{"id":"A279","pred":"tao:has_database_id","subj":"279","obj":"Tax:9606"},{"id":"A280","pred":"tao:has_database_id","subj":"280","obj":"Tax:9606"},{"id":"A281","pred":"tao:has_database_id","subj":"281","obj":"Tax:9606"},{"id":"A282","pred":"tao:has_database_id","subj":"282","obj":"Tax:9606"},{"id":"A283","pred":"tao:has_database_id","subj":"283","obj":"Tax:9606"},{"id":"A284","pred":"tao:has_database_id","subj":"284","obj":"MESH:D009369"},{"id":"A285","pred":"tao:has_database_id","subj":"285","obj":"MESH:D009369"},{"id":"A286","pred":"tao:has_database_id","subj":"286","obj":"MESH:D009369"},{"id":"A287","pred":"tao:has_database_id","subj":"287","obj":"MESH:D009369"},{"id":"A290","pred":"tao:has_database_id","subj":"290","obj":"MESH:D009369"},{"id":"A291","pred":"ta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study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"LitCovid-PD-HP","denotations":[{"id":"T52","span":{"begin":86,"end":92},"obj":"Phenotype"},{"id":"T53","span":{"begin":556,"end":562},"obj":"Phenotype"},{"id":"T54","span":{"begin":1114,"end":1120},"obj":"Phenotype"},{"id":"T55","span":{"begin":2367,"end":2373},"obj":"Phenotype"},{"id":"T56","span":{"begin":2437,"end":2443},"obj":"Phenotype"},{"id":"T57","span":{"begin":2783,"end":2789},"obj":"Phenotype"},{"id":"T58","span":{"begin":3194,"end":3200},"obj":"Phenotype"},{"id":"T59","span":{"begin":3299,"end":3305},"obj":"Phenotype"},{"id":"T60","span":{"begin":3323,"end":3329},"obj":"Phenotype"},{"id":"T61","span":{"begin":3852,"end":3858},"obj":"Phenotype"},{"id":"T62","span":{"begin":3975,"end":3981},"obj":"Phenotype"},{"id":"T63","span":{"begin":5205,"end":5213},"obj":"Phenotype"},{"id":"T64","span":{"begin":5325,"end":5333},"obj":"Phenotype"},{"id":"T65","span":{"begin":5813,"end":5821},"obj":"Phenotype"},{"id":"T66","span":{"begin":6418,"end":6424},"obj":"Phenotype"},{"id":"T67","span":{"begin":6542,"end":6548},"obj":"Phenotype"},{"id":"T68","span":{"begin":6908,"end":6914},"obj":"Phenotype"},{"id":"T69","span":{"begin":7011,"end":7017},"obj":"Phenotype"}],"attributes":[{"id":"A52","pred":"hp_id","subj":"T52","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A53","pred":"hp_id","subj":"T53","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A54","pred":"hp_id","subj":"T54","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A55","pred":"hp_id","subj":"T55","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A56","pred":"hp_id","subj":"T56","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A57","pred":"hp_id","subj":"T57","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A58","pred":"hp_id","subj":"T58","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A59","pred":"hp_id","subj":"T59","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A60","pred":"hp_id","subj":"T60","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A61","pred":"hp_id","subj":"T61","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A62","pred":"hp_id","subj":"T62","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A63","pred":"hp_id","subj":"T63","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A64","pred":"hp_id","subj":"T64","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A65","pred":"hp_id","subj":"T65","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A66","pred":"hp_id","subj":"T66","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A67","pred":"hp_id","subj":"T67","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A68","pred":"hp_id","subj":"T68","obj":"http://purl.obolibrary.org/obo/HP_0002664"},{"id":"A69","pred":"hp_id","subj":"T69","obj":"http://purl.obolibrary.org/obo/HP_0002664"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"LitCovid-sentences","denotations":[{"id":"T100","span":{"begin":0,"end":10},"obj":"Sentence"},{"id":"T101","span":{"begin":11,"end":112},"obj":"Sentence"},{"id":"T102","span":{"begin":113,"end":313},"obj":"Sentence"},{"id":"T103","span":{"begin":314,"end":435},"obj":"Sentence"},{"id":"T104","span":{"begin":436,"end":1335},"obj":"Sentence"},{"id":"T105","span":{"begin":1336,"end":1608},"obj":"Sentence"},{"id":"T106","span":{"begin":1609,"end":2201},"obj":"Sentence"},{"id":"T107","span":{"begin":2202,"end":2374},"obj":"Sentence"},{"id":"T108","span":{"begin":2375,"end":2696},"obj":"Sentence"},{"id":"T109","span":{"begin":2697,"end":2912},"obj":"Sentence"},{"id":"T110","span":{"begin":2913,"end":3041},"obj":"Sentence"},{"id":"T111","span":{"begin":3042,"end":3306},"obj":"Sentence"},{"id":"T112","span":{"begin":3307,"end":3603},"obj":"Sentence"},{"id":"T113","span":{"begin":3604,"end":3795},"obj":"Sentence"},{"id":"T114","span":{"begin":3796,"end":3999},"obj":"Sentence"},{"id":"T115","span":{"begin":4000,"end":4258},"obj":"Sentence"},{"id":"T116","span":{"begin":4259,"end":4489},"obj":"Sentence"},{"id":"T117","span":{"begin":4490,"end":5084},"obj":"Sentence"},{"id":"T118","span":{"begin":5085,"end":5366},"obj":"Sentence"},{"id":"T119","span":{"begin":5367,"end":5525},"obj":"Sentence"},{"id":"T120","span":{"begin":5526,"end":5779},"obj":"Sentence"},{"id":"T121","span":{"begin":5780,"end":6093},"obj":"Sentence"},{"id":"T122","span":{"begin":6094,"end":6295},"obj":"Sentence"},{"id":"T123","span":{"begin":6296,"end":6398},"obj":"Sentence"},{"id":"T124","span":{"begin":6399,"end":6537},"obj":"Sentence"},{"id":"T125","span":{"begin":6538,"end":6660},"obj":"Sentence"},{"id":"T126","span":{"begin":6661,"end":7103},"obj":"Sentence"},{"id":"T127","span":{"begin":7104,"end":7295},"obj":"Sentence"}],"namespaces":[{"prefix":"_base","uri":"http://pubannotation.org/ontology/tao.owl#"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}

{"project":"2_test","denotations":[{"id":"32986516-32220659-58490041","span":{"begin":584,"end":586},"obj":"32220659"},{"id":"32986516-32395672-58490041","span":{"begin":584,"end":586},"obj":"32395672"},{"id":"32986516-32242095-58490041","span":{"begin":584,"end":586},"obj":"32242095"},{"id":"32986516-32325021-58490042","span":{"begin":1871,"end":1873},"obj":"32325021"},{"id":"32986516-32212516-58490043","span":{"begin":2196,"end":2198},"obj":"32212516"},{"id":"32986516-32416784-58490043","span":{"begin":2196,"end":2198},"obj":"32416784"},{"id":"32986516-32221579-58490043","span":{"begin":2196,"end":2198},"obj":"32221579"},{"id":"32986516-32196543-58490043","span":{"begin":2196,"end":2198},"obj":"32196543"},{"id":"32986516-32339482-58490044","span":{"begin":3601,"end":3603},"obj":"32339482"},{"id":"32986516-32243287-58490045","span":{"begin":4830,"end":4832},"obj":"32243287"},{"id":"32986516-32439872-58490046","span":{"begin":4836,"end":4838},"obj":"32439872"},{"id":"32986516-32212516-58490047","span":{"begin":5073,"end":5075},"obj":"32212516"},{"id":"32986516-32196543-58490048","span":{"begin":5076,"end":5078},"obj":"32196543"},{"id":"32986516-32289312-58490049","span":{"begin":5082,"end":5084},"obj":"32289312"},{"id":"32986516-32424196-58490050","span":{"begin":5255,"end":5257},"obj":"32424196"},{"id":"32986516-32264957-58490051","span":{"begin":6293,"end":6295},"obj":"32264957"},{"id":"32986516-32264957-58490052","span":{"begin":6933,"end":6935},"obj":"32264957"},{"id":"32986516-32452031-58490053","span":{"begin":7290,"end":7292},"obj":"32452031"}],"text":"DISCUSSION\nOur study demonstrated the far-reaching impact of the COVID-19 pandemic on cancer services worldwide. Most of the centers faced challenges in maintaining the same level of care as before the pandemic, and therefore, they reduced or adjusted their services to different degrees using various approaches.\nThe main reason to reduce services was a precautionary measure to minimize patient visits and maintain social distancing. These are prudent actions recommended by many of the published guidelines and recommendations on managing patients with cancer during this pandemic.15-19 Many of these guidelines were made to the best judgment of authors and based on anecdotal experience as well as reports from frontline oncologists in the current pandemic or from those who had previous experience in infectious outbreaks such as Middle East respiratory syndrome and severe acute respiratory syndrome.20 However, because there were many unknown facts about the pandemic and how it would affect an individual country or even an individual institution—in addition to the inherent heterogeneity of patients with cancer and health care systems—many arbitrary decisions were made, and the impact of these decisions on patients care and outcome deserves further investigation to help to create an evidence-based approach for the future. On the other hand, there were other involuntary causes for reducing the level of care provided that are worth reflecting on to avoid them or at least minimize their impact during any future crisis, including staff shortage, PPE shortage, and lack of access to medications.\nAs frontline fighters of the pandemic, it is critical to manage health care staff well during the crisis and to be able to deliver care to all patients and prevent patients from exposure to different harms, such as infection, emotional disorders, and burnout.21,22 Shortage of PPE is a major concern because it exposes patients and health care staff to risk of infection or treatment interruption, compromises patient care, and leads to stress and discontent among staff.23 Addressing this issue requires a multilayered approach from all stakeholders, including the country’s government.24-27\nManaging medication formulary during a crisis is an essential function of organization leaders to ensure continuity of delivery of timely treatment to patients with cancer. Pharmacy management should ensure that an adequate supply for cancer and noncancer medications is maintained.28 Major regulatory agencies, such as the US Food and Drug Administration and European Medicines Agency as well as the United Nations, have initiatives and guides to address drug shortages during a pandemic.28-31\nWith more than a third of the participants reporting potential harms to patients with cancer from the disruption of usual care, some centers reported that up to 80% of their patients had exposure to potential harms. Although these numbers varied among centers, patient harm was certainly encountered by many oncologists because of the pandemic. The exact magnitude should be determined with time and future systematic studies because there are different risks of harm, including issues related to cancer management and noncancer-related management of other medical conditions that affect patients with cancer. The spectrum of cancer-related harm is wide and includes halting screen-ing and prevention efforts, delaying timely diagnosis and staging of new patients, delaying initiation of therapy, interrupting ongoing treatment, delivering suboptimal palliative care, and disrupting clinical research.32,33\nLimitations of the study include capturing the information in the midst of a pandemic, with variation in its severity in these countries and the full picture of pandemic impact still unclear. However, this study is important to paint the status of cancer care at a global level and will serve as a baseline for follow-up to assess the long-term effect of the pandemic on cancer care and outcome.\nThe study was completed by experts from these centers who provided their best estimates of certain data, such as patient harm, but this information is not backed by actual data, which are needed in future studies to get a better measurement of the real harm. In addition, participation in this study was voluntary and may have been skewed because responding physicians are willing to share information while nonresponding physicians may not be willing or able to do so for various reasons. The study may not have adequate representation from certain regions in the world such as sub-Saharan Africa and other regions, but the sample size helped us to perform an analysis that enabled us to draw plausible conclusions about the challenges encountered in poor countries with limited resources, emphasizing previous reports by others.12,14,34 Of note, scarcity of resources during the peak of the pandemic was encountered even in affluent countries with overwhelmed health care systems, which raises the need for a structured approach to resource management during such crises.24,27,35,36\nAs the pandemic evolves, we are gaining new knowledge and adjusting some older approaches, and this is valuable for the oncology field and health care systems in general.37 What we are sure of is that a new normal of health care, including oncology, will emerge after the pandemic. This new normal will involve more remote care; care closer to home; and more use of technology in care delivery, research, education, and business management. In addition, we may find that omitting cycles in maintenance therapy or fewer patient office visits or surveillance tests may not have a negative impact on outcome, although this will need prospective evaluation with properly conducted clinical studies.\nTelehealth and digital health in oncology can be an excellent tool for real-time video consultations for primary care triage and interventions, such as counseling, medication prescribing and management, management of long-term treatment, and postdischarge coordination supported by remote monitoring capabilities. It can be also a useful tool for wellness interventions and in areas such as health education, physical activity, diet monitoring, health risk assessment, medication adherence, and cognitive fitness.38\nLessons learned from this pandemic should be become an integral part of the new normal of health care. The integration of cancer care as a part of the institutional emergency preparedness plan will improve patient outcomes in similar crises. The cancer care continuum should have a major component of effectively managing patients during pandemics or major crises. Thus, we not only avoid harms in any future pandemic but also use the momentum gained from the current one to improve overall health care delivery for our patients and enhance the quality of care across borders by large-scale collaborations among cancer care stakeholders.38 These collaborations and initiatives should aim to close the global gap in cancer care created by the disparity in access to resources and exacerbated by the pandemic. This can be achieved by a multipronged approach, including the use of technology and other innovative approaches to improve care not just across borders but even within the same country.39-42"}