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The ongoing coronavirus disease 2019 (COVID-19) pandemic has left patients with current or past history of cancer facing disparate consequences at every stage of the cancer trajectory. This comprehensive review offers a landscape analysis of the current state of the literature on COVID-19 and cancer, including the immune response to COVID-19, risk factors for severe disease, and impact of anticancer therapies. We also review the latest data on treatment of COVID-19 and vaccination safety and efficacy in patients with cancer, as well as the impact of the pandemic on cancer care, including the urgent need for rapid evidence generation and real-world study designs. SIGNIFICANCE: Patients with cancer have faced severe consequences at every stage of the cancer journey due to the COVID-19 pandemic. This comprehensive review offers a landscape analysis of the current state of the field regarding COVID-19 and cancer. We cover the immune response, risk factors for severe disease, and implications for vaccination in patients with cancer, as well as the impact of the COVID-19 pandemic on cancer care delivery. Overall, this review provides an in-depth summary of the key issues facing patients with cancer during this unprecedented health crisis.

Summary Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57–76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53–2·21), male sex (1·63, 1·07–2·48), smoking status (former smoker vs never smoked: 1·60, 1·03–2·47), number of comorbidities (two vs none: 4·50, 1·33–15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11–7·18), active cancer (progressing vs remission: 5·20, 2·77–9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79–4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07–0·84) or the US-Midwest (0·50, 0·28–0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. Funding American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

BACKGROUND/AIMS: While overall rates of colorectal cancer (CRC) have declined in individuals aged above 50 years of age, this decline has not been seen in younger individuals who do not benefit from current screening guidelines. We sought to describe the prevalence of CRC in adults 20-39 years of age without family history of CRC or Inflammatory Bowel Disease (IBD)- Early Onset CRC (EoCRC), evaluate associated signs and symptoms and medical co-morbidities in EoCRC and compare them with individuals aged 20-39 years without CRC (NoCRC). Our secondary aim was to compare EoCRC with individuals aged 40 years and above with CRC (LoCRC). METHODS: Utilizing a commercial database (Explorys Inc, Cleveland, OH), we identified a cohort of patients aged 20-39 years with first ever diagnosis of CRC between 2013 and 2018 based on the Systematized Nomenclature of Medicine-Clinical Terms. We calculated the overall prevalence rate of EoCRC, described age, race, and gender-based prevalence rates of EoCRC, and identified associated symptoms and medical co-morbidities associated with EoCRC. RESULTS: The overall rate of EoCRC was 18.9/100,000. Compared to NoCRC, EoCRC patients were more likely to be Caucasian and female, with predominant symptoms of hematochezia, anemia, and decreased appetite. EoCRC group had higher prevalence rates of medical comorbidities such as diabetes, smoking, and obesity. Compared to LoCRC, EoCRC group presented more frequently with left sided CRC and rectal cancers. CONCLUSION: This is one of the largest studies to date to describe the epidemiology of EoCRC in US. We found EoCRC to occur predominantly in the Caucasian and female population. EoCRC presented more frequently with left sided and rectal CRC. We also identified signs/symptoms as well as comorbidities associated with EoCRC. Patients with these features may benefit from earlier screening.

Objective Prevertebral soft tissue swelling (PSTS) is a known complication of anterior cervical fusion (ACF). Prior studies have shown that perioperative steroids may reduce PSTS after ACF. We retrospectively evaluated the role of perioperative intravenous (IV) corticosteroid administration in minimizing radiographic PSTS measurements in patients undergoing ACF for degenerative disease. Methods Records of 100 consecutive patients undergoing ACF for degenerative disease (Current Procedural Terminology code 63075) from January 2010 through December 2012 by 2 orthopedic spine fellowship-trained surgeons at a single institution were retrospectively reviewed. Patients were included on the basis of specific criteria. They were then separated into comparison and IV steroid groups. Demographic and surgical data were collected. Last, measurements of PSTS, which included PSTS ratio and PSTS index (PSTSI), were obtained from plain radiographs preoperatively and at 3 postoperative time points. Results Eighty patients were included; 26 received IV steroids at the surgeon's discretion (12 intraoperatively, 11 postoperatively and 3 at both time periods). With the exception of a history of prior anterior cervical spine surgery (3.70% comparison vs. 23.08% IV steroid, P = 0.01), there was no statistically significant demographic characteristic. Furthermore, there was no statistically significant surgical characteristic. Last, there was no statistically significant difference between groups at any time point for either PSTS ratio at any level or PSTSI. Conclusions There does not appear to be a role for perioperative IV steroid administration in minimizing radiographic PSTS in patients undergoing ACF for degenerative disease. The relationship between perioperative IV steroid administration and PSTS requires further investigation.

BACKGROUND: Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS: Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS: A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS: Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER: NCT04354701.

In 2015, some members of the Humanities Faculty at the University of Cape Town proposed that animal products be taken off the menu at official Faculty functions. The proposal was rejected. Cordeiro-Rodrigues, in his paper “The racialization of animal advocacy in South Africa”, this journal, blames the proposers for this rejection, claiming that “the proposal’s approach neglects the racialized history of animal advocacy in South Africa, while also being carried out at an inopportune time and context.” We dispute Cordeiro-Rodrigues’ claims on a number of grounds, and argue that not only does he fail to substantiate his claims against the proposers, he also mischaracterizes the history of animal advocacy in South Africa, and, most worryingly, ignores the immense suffering perpetrated on animals in animal agribusiness.

A little-known feature of the vast migrant labour system that supplied South Africa’s gold-mining industry was the Deferred Pay Interest Fund. For much of the 20th century, a portion of the wages owed to African mine workers was deferred and remitted to them only at the end of their contracts. This is well-known, but what happened to the interest that accumulated on these deferred wages remains virtually unknown. Mine workers did not receive this interest; it was, instead, deposited into a fund controlled by the mining industry. This article examines the operations of this fund in the Transkei in the context of the crisis in the migrant labour system precipitated by newly independent states refusing to supply further migrant labour to South Africa. This prompted the Chamber of Mines to reorient labour recruitment towards the South African bantustans, and the Transkei quickly became the most important source of labour for the mines in the 1970s and 1980s. Although the fund had a mandate to spend on welfare projects in labour-sending regions, we argue that patterns of spending clearly show how it was used to support the reproduction of the migrant labour system. Payments were used as patronage for local elites, upon whom recruitment depended, and for distributing propaganda for the mining industry. In contrast, payments were consistently directed away from education for able-bodied students, because education would reduce the pool of unskilled labour on which the gold industry relied. Money that, arguably, rightfully belonged to mine workers from the Transkei was used to perpetuate their dependence upon migrant labour to the mines.

PURPOSE:The response to the COVID-19 pandemic has affected the management of patients with cancer. In this pooled retrospective analysis, we describe changes in management patterns for patients with cancer diagnosed with COVID-19 in two academic institutions in the San Francisco Bay Area.MATERIALS AND METHODS:Adult and pediatric patients diagnosed with COVID-19 with a current or historical diagnosis of malignancy were identified from the electronic medical record at the University of California, San Francisco, and Stanford University. The proportion of patients undergoing active cancer management whose care was affected was quantified and analyzed for significant differences with regard to management type, treatment intent, and the time of COVID-19 diagnosis. The duration and characteristics of such changes were compared across subgroups.RESULTS:A total of 131 patients were included, of whom 55 were undergoing active cancer management. Of these, 35 of 55 (64%) had significant changes in management that consisted primarily of delays. An additional three patients not undergoing active cancer management experienced a delay in management after being diagnosed with COVID-19. The decision to change management was correlated with the time of COVID-19 diagnosis, with more delays identified in patients treated with palliative intent earlier in the course of the pandemic (March/April 2020) compared with later (May/June 2020) (OR, 4.2; 95% CI, 1.03 to 17.3; P = .0497). This difference was not seen among patients treated with curative intent during the same timeframe.CONCLUSION:We found significant changes in the management of cancer patients with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.

When the COVID-19 pandemic began, formal frameworks to collect data about affected patients were lacking. The COVID-19 and Cancer Consortium (CCC19) was formed to collect granular data on patients with cancer and COVID-19 at scale and as rapidly as possible. CCC19 has grown from five initial institutions to 125 institutions with >400 collaborators. More than 5,000 cases with complete baseline data have been accrued. Future directions include increased electronic health record integration for direct data ingestion, expansion to additional domestic and international sites, more intentional patient involvement, and granular analyses of still-unanswered questions related to cancer subtypes and treatments.

One challenge in seminar-style postgraduate courses is that some students are uncomfortable with discussing course content and concepts among their peers and in front of the lecturer in seminars. This article is a case study of the incorporation of Google Form questions into seminars in a postgraduate Economic History course, a tool intervention undertaken as a response to the challenge of some students’ seminar reticence. The study explores whether the tool intervention can from students’ perspectives stimulate conversation, and examines whether the objectives of the students and the lecturer were aligned in the learning activity. The article draws on two theories to frame the research: Engestrom’s (2001) third generation Activity Theory, employed to locate change-enabling contradictions and the objects of the educational activity, and Laurillard’s (2002) Conversational Framework as a theory of learning wherein students and the teacher interface with mutually accessible concepts. The study draws on interview data from structured interviews with students at the end of the course. The article contends that Google Forms are assistive in stimulating conversations around core concepts, and that a quaternary contradiction emerged between the lecturer and the individual student’s objects in the educational activity

135 Background: Black patients have a disproportionately high incidence and mortality from lung cancer. Despite the importance of clinical trials, there continue to be significant racial disparities in recruitment for pivotal registration studies. In 2016, the FDA recommended reporting racial enrollment with a minimum of 5 categories (White, Black, Asian, American Indian or Alaskan Native [AIAN] and Native Hawaiian or Pacific Islander [NHPI]). The International Committee of Medical Journal Editors also recommend reporting race and ethnicity. We evaluated race reporting and representation in registration trials for thoracic cancers. Methods: We reviewed the FDA website and identified all new drug licensing indications in thoracic malignancies (small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC) and mesothelioma) from 2006 to 2020. NSCLC was further classified as EGFR+, ALK+, other mutation and NOS (no driver mutation). Clinical trials cited on the licensing label for market authorization were recorded and the corresponding registration trial publication was identified. If race was unreported or underreported (defined as ≤3 groups) in the licensing study, then additional information was obtained from clinicaltrials.gov. We calculated the proportion of registration trials meeting FDA criteria and the proportion of each racial group in trials. Results: From 2006-2020, we identified 55 new licensing indications, involving 26 unique drugs; 5 approvals in SCLC, 49 approvals in NSCLC and 1 in mesothelioma. Prior to the FDA race reporting guidelines, 33% (6/18) of registration studies did not meet FDA requirements. This improved to 27% (10/37) after the guideline introduction. Overall 29,545 patients participated in thoracic registration trials; 66% White, 22% Asian, 2% Black

1535 Background: The COVID-19 pandemic affected oncology practice in ways that are still evolving. In particular, COVID-19 has led to changes in cancer treatment for patients (pts) infected with COVID, which may have long-term implications for both COVID and cancer-related outcomes. In this retrospective analysis, we describe changes in cancer management over time for cancer pts diagnosed with COVID-19 at two academic institutions in Northern California. Methods: Adult and pediatric pts diagnosed with COVID-19 receiving active cancer management, defined as therapy/surgery/diagnostics within 3 weeks of COVID diagnosis, were identified through the EMR. Patients whose care was affected by COVID-19 were identified and analyzed for significant intra-group differences with regards to management type, treatment intent, and the time of COVID-19 diagnosis (“early” was defined as March to June 2020 and “late” as July 2020 to January 2021). The duration and characteristics of such changes were compared across subgroups. Chi-squared test was used to compare the incidence of delays between subgroups. Results: Among 134 COVID-positive pts on active cancer management, 83 (62%) had significant changes in management that consisted primarily of treatment delays. More delays were identified in patients treated with curative intent earlier in the course of the pandemic compared to later (OR 4.1, p=0.022). This difference was not seen among pts treated with palliative intent. In addition, pts on oral (PO) therapy were significantly less likely to have treatment changes than those on IV/IM therapy (OR 0.32, p=0.005). This difference was driven by a decrease in management changes for those on PO therapy in the later time period (OR 0.27, p=0.026). Pts diagnosed later were more likely to have delays due to clinical reasons rather than institutional policy (OR 6.2, P

This chapter reflects on whether the vegan injunction to not kill and hurt animals is inherently racist, and, in the South African and African context, whether cultural reasons can be fairly used to deny animal rights. The chapter considers two examples in which cultural reasons were invoked to deny animal rights, and animal rights endeavours were cast as racist. It examines both African and Western conceptions of animals and argues that almost all human cultures maintain a conspiracy against animals. The chapter submits that vegan activism is not inherently racist and that opposing racism is consistent with veganism, implying that it is inconsistent to oppose racism and not oppose animal killing and harm. It concludes that anti-racism and veganism are appropriately considered as aligned social justice projects.

The association between inflammation and cancer has been established in certain forms of human malignancies; however, its role in prostate cancer remains unclear. The present study investigates a possible association between chronic inflammation and the development of epithelial neoplasia in the prostate. Needle biopsy specimens were obtained from patients with serum prostate-specific antigen levels >4 ng/ml, evaluated for morphological findings, and immunostained for Bcl-2 and proliferating cell nuclear antigen (PCNA). Bcl-2 is a survival protein that appears to lie at a nodal point in pathways involved in cell survival, carcinogenesis, and development of therapeutic resistance in certain cancer types. Similarly, PCNA is a critical protein for DNA replication, repair of DNA damage, chromatin structure maintenance, chromosome segregation and cell-cycle progression. The association between these two proteins was examined in prostate tissues with and without chronic inflammation, as well as tissues with and without evidence of neoplastic changes. Of the 106 needle biopsies examined, 18% exhibited atrophy with inflammation. Proliferative inflammatory atrophy/post-atrophic hyperplasia were observed in 42%, high-grade prostatic intraepithelial neoplasia (HGPIN) in 8%, prostatic adenocarcinoma in 11%, and 2% had atypical acinar proliferation suspicious for malignancy. A total of 36 specimens were stained for Bcl-2 and PCNA. Bcl-2 was expressed widely in inflammatory and epithelial tissue; however, more intense expression was observed in the areas of chronic inflammation, predominantly in infiltrating immune cells. The highest proliferation index was observed in the epithelia of HGPIN and cancer. An inverse correlation between the expression of Bcl-2 and the expression of PCNA was observed in the epithelium. The areas of chronic inflammation were associated with increased Bcl-2 expression, whereas the highly proliferative epithelium minimally expressed Bcl-2. These results suggest that Bcl-2 alters the phenotype of particular epithelial cells with a gain in neoplastic characteristics, leading to a likely precursor that may later progress into HGPIN and cancer.