Patient blood management in oncology in the Russian Federation: Resolution to improve oncology care [Менеджмент крови пациентов в онкологии в Российской Федерации. Резолюция во имя улучшения оказания помощи онкологическим больным]
The huge global burden of oncological diseases is growing and measures to counter this complex challenge are high on national health agendas. The Russian National Long-Term Oncology Strategy 2030 defines priorities, goals and directions in the fight against cancer. It also contains action plans for more effective prevention, earlier and more specific diagnosis and more effective treatment options. Against this backdrop, experts now suggest to complement standard oncology treatment strategies by adding Patient Blood Management (PBM). For many clinical disciplines where a low blood count and considerable blood loss are commonly encountered, this bundle of care is the new standard. Based on clinical and scientific evidence, it aims to optimise medical and surgical patient outcomes by clinically managing and preserving a patient's blood. The principles of this comprehensive concept can and must be transferred to oncology, thus offering value in improving cancer care and the efficacy of medical institutions. Accumulating evidence demonstrates that anaemia and iron deficiency, but also thrombocytopenia, blood loss and coagulopathy are independent risk factors for adverse patient outcomes including morbidity, mortality, reduced quality of life and prolonged average length of hospital stay in both surgical and medical patients. For the timely and effective detection and correction of these risk factors, an international network of multi-disciplinary clinicians and researchers has developed PBM. The rapidly growing body of evidence for PBM not only shows improved patient outcomes, but also reduced resource utilisation including the use of allogeneic blood components. The reduction of allogeneic blood transfusion further improves patient safety and outcomes, since transfusion is another independent risk factor for adverse outcomes. Supported by WHO endorsements and following the recommendations of an increasing number of state or national health authorities, PBM is about to become a new standard of care. However, even though the aforementioned risk factors are highly prevalent in oncology settings due to chemo-/radiotherapy and the pathology of the disease, the integration of PBM in standard oncology treatment pathways is lagging behind. Thus, and in support of the Russian National Long-Term Oncology Strategy 2030 to improve quality of oncological care, with the support of the National Association of Specialists in PBM (NASPBM), the PBM Oncology Working Group of the Russian Federation was created, consisting of national and international experts in oncology and PBM. On July 9, 2020, the Working Group met to discuss the rationale for PBM in oncology and to assess the need to implement PBM in Russian oncology care. As a result, the Group recommended to include PBM as an integral part of standard oncology treatment pathways, delineated the action required from facilitating stakeholders in the Russian Federation, determined a roadmap for implementation and developed a national resolution as a call to action on the matter. Presented herein, this resolution acknowledges the global and local impetus to reduce cancer mortality, and the rationale for PBM interventions to improve patient outcomes and alleviate the social and economic burden of cancer on the healthcare system. © Consilium Medikum. All rights reserved.
Malignant neoplasms mortality rates in Moscow and Saint Petersburg in 2015 and 2018 [Смертность населения от злокачественных новообразований в Москве и Санкт-Петербурге в 2015 и 2018 годах]
Significant differences in mortality rates of the most of the death causes were detected between Moscow and Saint-Petersburg in the number of researches. Aim. Comparison and ranging of standardized mortality rates (SMR) from malignant neoplasms (MN) of different localizations in Moscow and in Saint-Petersburg in 2015 and 2018; determination of the localizations with main input in SMR from MN. Materials. Number of citizens and number of deaths from tumors accordingly to Rosstat Short nomenclature of the death reasons were evaluated. Death rates were calculated using the special computer programs on the base of European standard, comparison was provided with help of non-parametric criteria. Results. SMR of 29 from 33 MN localizations became lower in 2018 comparing to 2015 both in Moscow and in Saint-Petersburg. The average SMR decreased in 2018 in Saint-Petersburg statistically significant (p=0.003) and in Moscow non-significant (p=0.34). The largest SMR value both in 2015 and in 2018 in Moscow and in Saint-Petersburg as well were registered from 7 cancer localizations (trachea, bronchus, lungs; large intestine; breast; pancreas; rectum; prostate). The share of these SMR localizations in all MN was 57% and 54% in Moscow and 57 and 56% in Saint-Petersburg correspondingly. SMR of all 7 localizations were lower in Moscow comparing to Saint-Petersburg. SMR was lower in 2018 comparing to 2015 in both cities. The share of MN of others, unspecified, non-classified, etc. localizations in all MN was 11% in 2015 in both cities. Its share was in 2018 13.5% in Moscow and 10.1% in Saint Petersburg. Conclusions. SMR of most MN was higher in Saint Petersburg as in Moscow both in 2015 and in 2018. The analyses of the effectiveness of screening programs and of health care organization for patients with MN with highest SMR is needed. The questions of the differential diagnostics (intravital and postmortem) and of control the quality of medical death certificates filling in should be solved for the decrease of mortality of “nonrefinement” MN. © 2020 Consilium Medikum. All rights reserved.
Causal therapy of COVID-19: Critical review and prospects
The COVID-19 outbreak started in December 2019 in China has spread over all countries of the world within few month acquiring a pandemic nature, the incident population counting millions. The pathogenic mechanisms of the new coronaviral infection caused by never-before-seen virus SARS-CoV2 are yet to be studied. Various drugs are used for COVID-19 treatment and guidelines are continuously revised as new experience is acquired. In the current pandemic situation, it is important to provide specialists with latest information con-cerning efficacy and safety drugs for COVID-19 patients and promising research in this field. The purpose of the review is to critically analyze published data on outcomes of COVID-19 treatment with various drugs including potentially promising drugs. The search has been carried out through such databases as PubMed, Scopus, Cyberleninka, https://www.globalclinicaltrialsdata.com, https://clinicaltrials.gov, Cochrane Library; mostly, randomized clinical trials-2020 and papers dedicated to candidate drugs have been considered. The paper is structured based on the drug’s action mechanism and contains parts dedicated to antiviral, immunomodulatory, and an-tibacterial therapies. Looking for a new promising target in COVID-19 treatment, the authors focus their at-tention on matrix metalloproteinases (MMP), which abundance results in the destruction of extracellular ma-trix, epithelial and endothelial basal membranes and leads to secondary lung tissue injury. The paper provides a theoretic justification of MMP inhibitor use by an example of doxycycline and offers an efficacy study protocol for the new approach to COVID-19 therapy. Conclusion: as of now, there are no drugs which efficacy for COVID 19 has been proven. Drugs possessing multiple mechanisms of action are employed beside their specified indications, often in combinations; in this situation, additive side effects with adverse consequences for the patient can hardly be avoided. Administration of drugs with unproven efficacy may be justified only in clinical trials followed by subsequent analysis and publication of findings demonstrating that in case of success, recommendations for a majority of COVID-19 patients could be confidently issued. © 2020, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
Hyperbaric oxygen therapy in patients with COVID-19
The aim of the study is to evaluate the efficacy of hyperbaric oxygen therapy and its effect on oxidative stress and apoptosis in patients with new coronavirus infection COVID-19. Materials and methods. 90 patients diagnosed with new coronavirus infection caused by SARS-CoV-2 virus were examined. Hyperbaric oxygen therapy sessions were conducted in 57 patients (38 in severe condition (CT 3–4), 19 in moderate condition (CT 1–2)). The procedures were performed in 1.4–1.6 ATA mode for 40 min-utes, 247 sessions in total were performed. The effect of hyperbaric oxygenation was assessed by measuring the level of oxygen saturation, the severity of oxidative stress and apoptosis of blood lymphocytes. Results. In all examined patients with new coronavirus infection caused by SARS-CoV-2, positive changes such as dyspnea reduction and improvement of general well-being were registered after hyperbaric oxygen therapy sessions. The level of oxygen saturation after the end of the hyperbaric oxygen therapy course was 95.0±1.6% (before the course — 91.3±5.9%), which allowed to return almost all patients to spontaneous res-piration without the need for further oxygenation therapy. Hyperbaric oxygen therapy did not reduce the total antioxidant activity, however, it was associated with a decrease in the blood malone dialdehyde from 4.34±0.52 µmol/l to 3.98±0.48 µmol/l and a decrease in open circuit potential of platinum electrode from-22.78±24.58 mV to-37.69±17.4 mV. Besides, the positive effect of hyperbaric oxygen therapy was manifested in normalization of blood cell apoptosis. Conclusion. Hyperbaric oxygen therapy in patients with new coronavirus infection caused by the SARS-CoV-2 virus is an effective treatment method with multiple effects resulting in improvement of subjective indicators of the patients' condition, increase of hemoglobin oxygen saturation, decrease of lipid peroxidation intensity, activation of antioxidant system, restoration of pro-and antioxidant balance and apoptosis normalization. © 2020, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.