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Background: Oncology patients have had to make many changes to minimise their exposure to COVID-19, causing stress. Despite education, some patients still do not recognise potential COVID symptoms., Aims: We assessed patient knowledge of COVID, and its impact on their behaviours, concerns, and healthcare experience., Methods: A 16-page questionnaire was distributed to 120 oncology patients attending the day unit of a tertiary Irish cancer centre for systemic anti-cancer therapy (May/June 2020). The Irish 7-day COVID incidence during this period ranged from 2 to 11 cases/100,000 people., Results: One hundred and one responses were received, 1% had tested positive for COVID, and 31% had undergone testing. Participant insight into their knowledge about COVID and their own behaviour was limited in some cases. Seventy-five percent reported total compliance with restrictions, but many were not fully compliant. Self-reported confidence in knowledge was high, but did not predict demonstrated knowledge. Sixty percent did not recognise two or more symptoms; 40% did not self-identify as high-risk. Patients reported more health-related worry (72%), loneliness (51%), and lower mood (42%) since the pandemic began. Financial toxicity worsened, with increased financial worry (78%), reductions in household income (40%), and increased costs due to lockdown (62%). Use of facemasks introduced new communications barriers for 67% of those with hearing loss., Conclusions: Despite self-reported confidence in knowledge, some patient's recognition of COVID symptoms and the preventative strategies they should use are not optimal, highlighting the need for further education in this regard. COVID has been a significant stressor for patients and more practical, financial, and psychological supports are needed., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: Virtual clinics were introduced to our practice in March 2020. We aimed to assess outcomes from virtual clinics and to assess staff views on them and their barriers to implementation nationally., Methods: We prospectively assessed outcomes from 53 planned virtual consultations in a cancer centre oncology outpatient department (April-July 2020). Thirty-two oncologists completed an online survey., Results: Visit durations ranged from < 5 min (n = 2, 4%) to 30 + min/patient (n = 9, 20%) (median: 18 min (range 4-141, IQR 10-30 min)). Median time spent preparing for patients who did not attend (n = 6, 11%) was 15 min (range 9-15 min). Most patients were scheduled for routine follow-up (n = 41, 87%), with some planned for an early in-person visit (n = 3) or investigation (n = 3). Where bloods had been requested (n = 25), samples had often not been taken (n = 20, 80%) or results were unavailable (n = 3, 12%). Different plans may have been agreed with two patients (4%) had they attended in-person. Virtual visits were perceived as faster by most doctors in the online survey (n = 26, 84%), with some (n = 5, 16%) reporting a difference of 10 min per patient. Many (n = 13, 42%) arranged earlier follow-up appointments. Low satisfaction was associated with difficulty with patient assessment (81%) or communication (63%), resource limitation (48%), or poor access to results of investigations (40%). The majority (n = 21, 67%) do not feel their virtual clinic quality is as good as in-person., Conclusions: If virtual clinics are to play a long-term role in oncology, it is essential to monitor clinic quality and plan visits proactively., (© 2021. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: Some studies indicate that survival of adolescents and young adults (AYA) with cancer may be inferior to that of younger children with similar cancers, possibly related (in part) to differences in access to centralized or standardized treatment., Aims: This study aims to evaluate differences in survival for AYA patients when compared with paediatric patients treated in Ireland over a 20-year time period., Methods: This study compares relative survival for patients diagnosed in Ireland at ages 0-15 (paediatric group) and 16-24 (AYA group) during 1994-2013, followed to the end of 2014, for cancers defined by the International Classification of Childhood Cancer (ICCC) (Third Edition) group or subgroup. Five-year relative survival estimates, and excess hazard ratios (EHR) comparing excess mortality associated with a cancer diagnosis among AYA with that in the paediatric group, are presented. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., Results: Significantly higher excess mortality was found for AYA with leukaemias, lymphomas, astrocytomas, malignant bone tumours, and Ewing and related bone sarcomas, soft tissue sarcomas and 'other/unspecified' epithelial cancers, rhabdomyosarcomas, and 'other and unspecified' carcinomas. In contrast, lower excess mortality was found in the AYA group for all cancers and intracranial/intraspinal tumours, and for gliomas other than astrocytomas or ependymomas. Comparing 1994-2003 and 2004-2013 cohorts, age-related survival differences narrowed for lymphoid leukaemias, but widened for all cancers combined and intracranial/intraspinal tumours combined. Centralization of services varied depending upon cancer subtype, with leukaemias, CNS tumours and bone sarcomas most centralized. Within these, improvements in survival for leukaemias and CNS tumours have been seen for the AYA population., Conclusions: Reasons for age-related survival differences, and differences in time-trend by age group, are not clear. The significant narrowing of survival differences by age in more recent years for lymphoid leukaemias reflects a more marked recent increase in survival among AYA. More work is required to explain and improve other age-related survival differences.