The Hospice Care Professionals Association (HCPA) continues the two-year course on palliative care launched in 2020 for medical universities’ teachers.
At the end of 2020, the HCPA and the Federal Scientific and Practical Center for Palliative Medical Care of Sechenov University, with the support of the Global Palliative Care Program of Massachusetts General Hospital/Harvard Medical School and the World Health Organization Regional Office for Europe, conducted an educational online-course with teachers of 9 medical universities of the Russian Federation. Starting from April 2021, the ToT course’s lecturers will take part in palliative care programs in participating universities.
Our lecturers: Eric Krakauer (Harvard Medical School), Stephen Connor (WHPCA), Tom Smith (Johns Hopkins University), Diana Nevzorova (HCPA), Eugenia Krotova (USA), Galina Khemlina (USA), Guzel Abuzarova (Moscow), Alexander Sidorov (Yaroslavl’), Olga Osetrova (Samara), Egor Larin (Moscow), Kudrina Oksana (Sechenov University).
The American Eurasian Cancer Alliance, an active partner and associate of the Hospice Care Professionals Association, is celebrating its 20th anniversary this year!
The Alliance is committed to improving the quality of life and treatment of those facing cancer, uniting physicians and researchers’ efforts in the North American and Eurasian regions, developing international cooperation in cancer treatment and research.
An essential area of the Alliance's activities is in palliative care for cancer patients. For several years now, the Alliance has been actively supporting educational and scientific events of our Association.
The Hospice Care Professionals Association congratulates its partner on the anniversary and wishes him further success in its worthy activity!
At the end of 2020, the Hospice Care Professionals Association (HCPA) and the Federal Scientific and Practical Center for Palliative Medical Care of Sechenov University with the support of the Global Palliative Care Program of Massachusetts General Hospital/Harvard Medical School and the World Health Organization Regional Office for Europe and the assistance of the American Eurasian Cancer Alliance (AECA) and the World Hospice Palliative Care Alliance (WHPCA) conducted a large-scale educational online project for palliative care teachers of medical universities of Russia.
The course ТоТ (Training/teaching of Teachers) was attended by 22 employees of departments, where palliative care is being taught, from 9 medical educational institutions of different cities - St. Petersburg, Chelyabinsk, Tyumen, Nizhny Novgorod, Saransk, Kazan, Yaroslavl, Ryazan, Moscow take place.
The course was lectured by international and Russian experts and teachers, including Eric Krakauer (Harvard Medical School), Stephen Connor (WHPCA), Tom Smith (Johns Hopkins University), Diana Nevzorova (HCPA). The program covered various aspects of providing palliative care and the specifics of teaching this discipline. Particular attention was paid to the exchange of experience, discussions and interaction of participants in small groups. The course also included a detailed survey of the participants’ teaching experience, beliefs, and preferences, exploring their own “strong” and “weak” topics and difficulties in teaching palliative care.
The experience of the first ToT course, feedback from participants and questionnaires provided a factual basis for improving the course and tailoring it to the profile of the Russian PC teacher in order to meet best his or her needs, interests, knowledge gaps and the specifics of teaching at various medical universities in the country.
The importance of quality teaching for such a multifaceted discipline as palliative care, especially for the teachers themselves, is difficult to overestimate. This defines the importance of the project for the global goal of improving the quality and volume of teaching PC in the Russian Federation, which is especially relevant given its active development and the growing need for professional staff.
The organisers of the course decided to conduct the course annually.
A population survey on the prevalence of various forms of tobacco use among indigenous peoples of Russia. Forming a Population-Based Smoking Prevention, Tobacco Involvement and Harm Reduction Strategy.
The Russian Federation ranks fifth in the world in the number of tobacco smokers. The Russian government is making greater efforts to fight this, including under the aegis of the World Health Organization's tobacco control initiatives. ORBI Stroke Foundation actively participates in WHO initiatives and makes it a priority to support limiting tobacco use as one of the serious factors of stroke.
A new study published by a team of researchers in the journal World Epidemiology found that the most important indicators associated with smoking initiation that need further regulatory initiatives are smoking initiation age, sex, smoking by pregnant women and young mothers, and tobacco use by the older age group.
Despite the fact that in Russia there is a downward trend in smoking in the general population, in the territories of the Far North, Caucasus, remote regions of Eastern Siberia and the Far East, due to great remoteness, low media accessibility and, especially, due to traditional ways of life, there is no trend to decrease tobacco smoking. Indigenous and minority peoples living in these territories are at greater risk and need additional measures to protect them from smoking.
In a study conducted by the working group, together with volunteers from the ORBI Stroke Foundation, 45 papers with a focus on small indigenous peoples were found and analyzed from an array of international publications to estimate the prevalence of tobacco smoking and the dynamics of tobacco use in Russia. The research team found that smoking rates varied widely depending on age, indigenous ethnicity, gender, and the remoteness of the area in which the various ethnic groups lived.
Smoking has been found to be disproportionately high among indigenous peoples. For example, one study conducted among residents of the Yamal-Nenets Autonomous Region, covering the period from 1990 to 2003, reported that 92.7% of men smoked, while another study found that in 2015 there were 23.7% of female smokers among Evenks. Unfortunately, the relatively small amount of research on Indigenous smoking has made it difficult to analyze changes in Indigenous smoking prevalence over time.
Researchers could not find evidence that there were targeted and personalized anti-smoking programs in remote regions where most indigenous peoples live. Unfortunately, there is also no mention of cessation programs developed with any indigenous groups to ensure that programs are culturally adapted so that tobacco control measures are most effective, as recommended by the WHO Framework Convention.
"We would like to show the relevance of the need for further research on tobacco use among Indigenous Peoples and, together with government agencies, socially oriented non-profit organizations and health authorities, present options for effective tobacco control measures among Indigenous Peoples, residents of remote rural areas, especially among people with low income," the researchers say.
"International evidence shows that interventions developed with the participation of smaller ethnic groups can provide proportionately greater reductions in smoking-related harm for them. Working with more than 45 small indigenous peoples living in Russia, it will be especially important to identify the most effective interventions that will improve their health," the scientists said.
Dr. Alexander Merkin
Academy of Postgraduate Education.
Dr. Mareva Glover
Director, Center for Research Excellence: Sovereignty and Smoking among Indigenous Peoples.
Dr. Igor Anatolievich Nikiforov
Academy of Postgraduate Education.
Dr. Artem Nikolaev
Head Doctor of NIKAMED Ltd.
Dr. Alexander Komarov
Executive Director of "ORBI" Stroke Foundation
Director, National Center for Development of Social Support and Rehabilitation Technologies "Doverie".
When the coronavirus outbreak began, information about the mysterious virus that caused COVID-19 was scarce.
Governments and health services alike had to act on relatively limited information about the outbreak, while experts hurried to gather data on how the virus behaves and spreads, and who was most at risk.
Throughout this period of uncertainty – which severely affected cancer service, trials and research – people were being diagnosed with, or treated for cancer and millions were living the disease. And one of the big questions was – does having cancer affect someone’s risk of developing severe COVID-19 symptoms?
Now, as we enter our third lockdown, we now have a clearer picture of how COVID-19 affects people with cancer. Information that will be invaluable in supporting people with cancer during future waves of COVID-19, and in helping people understand their individual risk.
COVID-19 severity in people with cancer
Because mass testing wasn’t available at the start of the pandemic, most of the evidence we have comes from studies involving people who were admitted to hospital.
It’s clear from many of these studies that patients with COVID-19 admitted to hospital during the first wave were at risk of lung complications, needing intensive care and, sadly, death. A similar pattern emerged when looking at evidence involving people with cancer more specifically.
But does having cancer increase someone’s risk of developing severe COVID-19 symptoms? It turns out that’s a tricky question to untangle.
We know that in the general population, someone’s age, sex and underlying health conditions (such as cardiovascular disease) are linked to COVID-19 severity. Researchers have found that similar factors are also associated with COVID-19 severity in people with cancer. Because cancer is more common in older people, and people with cancer often have other health conditions as well as cancer (comorbidities), it can be difficult to unpick whether having cancer itself increase someone’s risk of developing severe COVID-19 symptoms, but researchers have been trying.
Results from a study of 20,000 hospital inpatients that took age, sex and some comorbidities into account found that having cancer was still associated with an increased risk of dying whilst still in hospital compared to COVID-19 patients without cancer, though the risk was lower than for people with other conditions like liver disease or dementia.
These results highlight the importance of maintaining COVID-19 protected spaces in hospitals for cancer tests, treatment and care, as we’ve blogged about before. But it may be that looking at people with cancer collectively isn’t the most helpful view, as risk may vary depending on the type of cancer someone has, the type of treatment they’re undergoing and how advanced their cancer is.
COVID-19 in different types of cancer
During the first wave of the pandemic, people with blood cancer were advised to shield as they may be at higher risk of worse outcomes from COVID-19. This is because cancers of the blood or bone marrow – such as lymphoma, leukaemia and myeloma – can lower your ability to fight infection by affecting your immune system.
Findings from the UK Coronavirus Cancer Monitoring Project (UKCCMP), which covered 61 UK centres, suggest that people with blood cancer are overrepresented in the group of people with cancer who tested positive for the virus – meaning they may be more likely to catch COVID-19 than people with other cancer types.
And research so far suggests that people with blood cancer are more likely to have severe COVID-19 compared with those diagnosed with solid tumours. However, experts say that studies haven’t factored in other comorbidities and larger numbers are needed to analyse the risk associated with individual blood cancers.
The SOAP study has looked at the immune response to the virus in people with solid and blood cancers. The findings of this study suggest that people with blood cancers may have a more variable response with some patients struggling to clear the virus. Read more about what this could mean for COVID-19 vaccination in our COVID-19 vaccine and cancer blog.
Researchers have also been looking into if people with lung cancer might be at higher risk of severe COVID-19. A few small studies have reported poor outcomes for a small cohort of patients with lung cancer and COVID-19.
But the UKCCMP study reported that the proportion of people who died after testing positive for COVID-19 was not significantly higher for patients with lung cancer than for patients with other types of cancer. One study has also reported current or past smoking as a risk factor for severe COVID-19 in people with lung cancer, but larger studies are needed to confirm this finding.
COVID-19 in people with cancer having different types of cancer treatment
Cancer treatment was heavily disrupted during the first wave of COVID-19, with many having their treatment delayed or altered because of the potential risks of COVID-19, or due to demands on the NHS during the pandemic.
Since the start of the pandemic, researchers have been working hard not only to monitor the impact of COVID-19 on people’s treatment, but also to understand the COVID-19 related risks of individual treatment options to help doctors and people with cancer make more informed decisions in future waves.
The biggest question mark was around surgery. Surgery was the worst hit during the first wave, mainly because of the demand for intensive care unit (ICU) beds. But there were also questions about risk, as having a big operation involving a hospital stay can make it more likely that someone will get an infection.
A large, international, ongoing study is aiming to answer questions about surgery and risk of severe outcomes from COVID-19. Findings from the COVIDSurg study have shown that having COVID-19 around the time of surgery – not just cancer surgery – leads to worse outcomes than were seen pre-pandemic, including higher rates of lung complications and higher risk of death. This initial data mainly looked at emergency surgeries, so may not be applicable to surgery in general.
COVIDSurg has begun to look at whether having had COVID-19 affects outcomes in people undergoing suspected cancer surgery. We don’t have the full findings yet, but initial results suggest that previous COVID-19 infection can increase the risk of lung complications.
The international team has also compared outcomes for patients undergoing cancer surgery in a COVID-protected environment with those having surgery in a hospital with no defined COVID-protected pathway during the height of the first wave. And the good news is it looks like COVID-protected environments do make a difference – rates of lung complications, COVID-19 infections following surgery and deaths were low in patients treated in a COVID-protected environment. This has been backed up by several other studies suggesting that it’s safe and feasible for patients to have elective cancer surgery in COVID-protected safe spaces in the UK.
Analysis of surgery for specific types of cancer is now starting to become available. International data from the first wave of the pandemic on over 2000 patients with colon or rectal cancer showed that most of these patients did not develop COVID-19 in the period after surgery. Developing COVID-19 in the period after surgery and complications after surgery were both associated with worse outcomes for patients.
COVIDSurg data are also now available of patients with head and neck cancers, a particular concern because of the chances of spreading infection by operating in the airway. The analysis of 1,137 patients shows that the majority did not develop COVID-19 in the period after surgery and that their outcomes were similar to those normally expected from this group of patients. While this suggests that the measures introduced to make surgery safer are working, there was an association between patients and members of the surgical team testing positive. This can probably be explained by in part by high levels of infection in the community. The data also show differences in the types of head and neck cancer patients having surgery to what you would normally expect to see suggesting that some patients received alternative treatment.
Beyond surgery, some people with cancer have also had changes made to their systemic anticancer treatment or the way in which this treatment has been provided to try to minimise their risk. For example, a switch to an oral treatment that can be taken at home rather than in hospital, or to a different drug with fewer side effects to reduce the impact on the immune system.
Radiotherapy was perhaps the least impacted type of cancer treatment and, in some cases, was even used as a treatment option for people who couldn’t have surgery or other treatments. There were some changes to radiotherapy – some patients were able to have the same overall dose of radiation in fewer visits to the hospital, reducing the risk of being infected.
But are patients receiving systemic anticancer therapy or radiotherapy at higher risk of severe COVID-19?
While some smaller studies of people with COVID-19 and cancer have suggested that recent systemic anticancer therapy is not associated with an increased risk of dying from COVID-19, other studies have reported an increased risk. This includes the QCOVID study, a large study using data on over 6 million adults from GP and other records to develop a tool to predict COVID-19 risk based on different factors. In this study, people receiving chemotherapy were found to be at increased risk of COVID-related hospital admission and death compared to people who hadn’t had chemotherapy in the past 12 months. Similarly, people who had radiotherapy within the last 6 months were also found to be at increased risk.
Some studies have looked at whether recent systemic anticancer therapy might increase risk specifically in patients with blood cancers. One study suggested that the risk is higher with recent treatment, but a recent review of multiple studies found no increase in risk.
How useful is this evidence?
Initially, evidence was limited to fairly small, single centre studies. But findings from some of the larger cohorts like COVIDSurg are now becoming available, including evidence from the UK.
The speed at which some of these studies were conceived, set up and data collected – while impressive –could have resulted in missing data. And when looking at factors associated with risk of severe disease or death in subgroups of patients, analyses may be limited by small numbers.
Finally, most of the studies have only looked at hospitalised patients, which may skew the results. And because of the way testing has been carried out in hospitals, some patients may have had unidentified asymptomatic infection, potentially affecting their outcomes. Finally the way hospitals care for people with COVID-19 has changed since the first wave, so some of this evidence may not reflect what happens now.
We’ve still got a lot to learn about this relatively new virus and how it affects people with cancer, including how prior infection affects treatment outcomes, how common less severe COVID-19 is in the cancer community and whether people with cancer could have a less effective immune response to infection or a vaccine. We’re summarising the latest COVID-19 vaccine news in a separate blog post.
With large studies ongoing, we’re learning more about people’s individual risk all the time, which will be vital to help make sure that everyone gets the right treatment and care for them during the pandemic.