Cancer stage and time from cancer diagnosis to first treatment during the COVID-19 pandemic

Impact of the COVID-19 Pandemic on Gut Cancer Admissions and Management: A Comparative Study of Two Pandemic Years to a Similar Pre-Pandemic Period

Background/Objective: Gastrointestinal tract cancers may have been severely affected by the COVID-19 pandemic. The limitations of digestive endoscopy, the fear effect, and restrictions on hospital admissions during the pandemic may have delayed the presentation of patients to hospitals and surgical procedures and may have impacted overall survival. Methods: We conducted an observational, cross-sectional study of esophageal, gastric, small bowel, and colorectal cancer patients admitted to our hospital between 1 January 2018 and 31 December 2021. We analyzed the hospitalization rates, pathological type, the onset by complications, staging, and surgery during the pandemic compared to a pre-pandemic period (January 2018-December 2019). Results: During 2018-2021, 1613 patients with malignant gut tumors were admitted to our hospital (112 esophageal and eso-cardial tumors, 419 gastric tumors, 34 small bowel tumors, and 1058 colorectal tumors). Admission was reduced by 30.3% for esophageal and eso-cardial malignant tumors, 27.6% for gastric tumors, and 17.3% for malignant colorectal tumors. For esophageal and eso-cardial tumors, a higher frequency of stenosing tumors and palliative gastrostomies was noted. More stage III gastric cancers and a lower rate of vascular invasion were recorded during the pandemic. No differences regarding small bowel tumors were noted. In colorectal tumors, slightly more stage II cancers and more stenosing tumors were recorded, but occlusive, bleeding, and perforated tumors were similar; also, surgical rates were similar, with a two-fold higher perioperative mortality. The overall survival of gastric and colorectal carcinoma was higher during the pandemic (but with no statistical significance), although a clear explanation has not emerged. Conclusions: The impact of the COVID-19 pandemic on gut cancer included a significantly lower rate of newly diagnosed admissions, more stage II colorectal and stage III gastric carcinomas, a two-fold higher perioperative mortality for colorectal carcinoma, and a trend for a surprisingly higher overall survival for gastric and colorectal tumors (but without statistical significance). Future research is necessary for assessing long-term impact.

Measuring the impact of COVID-19 on time to treatment for individuals diagnosed with cancer in Manitoba, Canada using an interrupted time series analysis

BACKGROUND

Delays in treatment can lead to increases in cancer morbidity and mortality. There were many concerns that the COVID-19 pandemic led to delays in cancer treatment. Several studies have examined this issue but with serious limitations. We conducted a study that addressed many of these limitations and evaluated changes in first treatment, surgery, systemic therapy, and radiation therapy (RT) during the pandemic for individuals diagnosed with cancer in Manitoba, Canada.

METHODS

A population-based, quasi-experimental cross-sectional study with an interrupted time series analysis was used to examine time to first treatment (expressed as treatment rates accounting for the competing risk of death) before (January 2015-September 2019) and after (April 2020-December 2022) the COVID-19 pandemic.

RESULTS

When compared to the counterfactual scenario without COVID-19, first treatments were not received significantly later during the COVID-19 period for any cancer site. Individuals diagnosed with breast, colon, endocrine, or head and neck cancer had their first treatment within 90 days of diagnosis significantly sooner when comparing the COVID-19 period to the counterfactual. When examining type of treatment within one year of diagnosis, individuals diagnosed with breast cancer had surgery significantly later from April to June 2020 and systemic therapy significantly sooner from April 2020 to September 2021. Individuals diagnosed with colon cancer had surgery significantly sooner from April 2020 to June 2021 and individuals diagnosed with rectal cancer had RT significantly later from January to June 2021.

CONCLUSIONS

Although significantly impacted by COVID-19, the cancer care system in Manitoba was able to prioritize individuals diagnosed with cancer and modify treatment modalities resulting in no significant delays in first treatment between April 2020 and December 2022.

POLICY SUMMARY

It will be important to assess long-term survival and if unaltered, the ongoing use of strategies first used in the pandemic might be justified.

Effect of the COVID-19 pandemic and lockdown on cancer stage distribution and time to treatment initiation using cancer registry data of the Swiss cantons of Zurich and Zug from 2018 to 2021

PURPOSE

Swiss healthcare institutions conducted only urgent procedures during the COVID-19 lockdown, potentially leading to a lack of care for other severe diseases, such as cancer. We examined the effects of the pandemic on cancer stage distribution and time between cancer diagnosis and treatment initiation using population-based cancer registry data.

METHODS

The study was based on data of the cancer registry of the cantons of Zurich and Zug from 2018 to 2021. Cancer stage distribution was analysed descriptively and with a Pearson's Chi-squared test. Time between cancer diagnosis and treatment initiation was determined in days and analysed descriptively and by fitting Quasipoisson regression models.

RESULTS

For all-cancer and colorectal, lung, and prostate cancer statistically significant evidence for a difference in cancer stages distribution among the incidence years was observed. Based on the all-cancer regression models, longer time to treatment initiation (TTI) was observed for patients diagnosed in 2021 and receiving surgery (Rate Ratio = 1.08 [95% confidence interval 1.03, 1.14]) or hormone therapy (1.20 [1.03, 1.40]) compared to those diagnosed in 2018/19 receiving those therapies. We observed no difference in TTI between cancer patients diagnosed in 2020 compared to 2018/19 for any of the therapies investigated, except for chemotherapy with shorter TTI (0.92 [0.86, 0.98]).

CONCLUSION

The observed effects on cancer outcomes in 2020 and 2021 compared to 2018/19 coincided with the beginning of the COVID-19 pandemic in Switzerland in 2020 onwards. Short- and long-term effects of the pandemic on cancer outcomes and the public healthcare system were observed. However, we cannot exclude that the implementation of the new Swiss law on cancer registration in 2020 explains part of our observations.

An approach to COVID‑19 and oncology: From impact, staging and management to vaccine outcomes in cancer patients: A systematic review and meta‑analysis

The COVID-19 pandemic has had a global impact, with >771 million confirmed cases and 6 million deaths reported by October 2023. Cancer patients, due to their immunosuppressed status, face an increased infection risk and higher COVID-19 complications. The present study aimed to assess clinical outcomes in COVID-19-infected cancer patients, focusing on mortality rates and other aspects, providing valuable insight for better protection and outcomes. This systematic review was conducted by searching the PubMed, Cochrane and Embase databases from August 2023 following the PRISMA guidelines. Studies from 2020 to 2023 pertaining to the impact of COVID-19 on patients previously diagnosed with malignancies were considered. Inclusion criteria entailed a pre-existing malignancy diagnosis, confirmed COVID-19 infection and an impact of COVID-19 on any aspect of the patient's cancer management. Studies written in English were exclusively reviewed. Post-COVID-19 malignancy diagnoses, case reports, review articles and data-insufficient studies were excluded. Screening and consensus on eligibility were carried out by a team of four authors, with disputes resolved by a non-screening author. Data extraction was performed by a five-author team, detailing study and population characteristics, as well as cancer patient outcomes related to COVID-19. Cross-checking was conducted by the same team, with conflicts resolved by a third author. The review of 27 studies explored COVID-19's impact on oncology, revealing diverse sample sizes (1,807,559 to 177 participants). Studies spanned various cancer types, including gastric adenocarcinoma, breast, lung, gynecologic, colorectal and non-melanoma skin cancer. Mortality rates were higher among cancer patients with COVID-19 compared to those without. Gastric adenocarcinoma exhibited a 5.9% mortality rate. Thoracic cancer patients faced elevated mortality and gastrectomies decreased. A meta-analysis (10 studies, 5,151 patients) showed a 19.1% mortality rate for COVID-19-infected cancer patients, contrasting with 1% for non-COVID-19 cancer patients (5 studies, 54,528 patients). The odds ratio for mortality in non-COVID-19 vs. COVID-19 cancer patients was 0.1036 (3 studies, 3,496 patients). Cancer patients consistently faced elevated mortality during the pandemic, with specific cancers showing unique impacts. Gastric adenocarcinoma exhibited a significant COVID-19 mortality rate. Patients with thoracic cancer faced increased risks, influencing surgical trends. Meta-analysis revealed an overall elevated mortality rate among COVID-19-infected cancer patients compared to non-COVID-19 counterparts.

Impact of the COVID-19 Pandemic on the Diagnosis of Malignant Neoplasia of the Bronchus and Lung in the Burgos Region

PURPOSE

To retrospectively analyze the impact of the COVID-19 pandemic on the diagnosis, mortality rate, and survival period of malignant bronchial and lung neoplasms in the Burgos region, with the aim of promoting the development of strategies to improve cancer care management during health crises, highlighting the importance of non-pharmacological approaches to mitigate the negative impacts of future pandemics on lung cancer patients.

METHODS

This retrospective, longitudinal, single-center study was conducted in Burgos from 2019 to 2021. Participants included all patients diagnosed with malignant bronchial and lung neoplasms by the Pneumology unit of Complejo Asistencial Universitario de Burgos during the year immediately before and the year immediately after 31 March 2020, the official start date of the pandemic. Inclusion criteria encompassed patients diagnosed through histological or clinicoradiological methods, who provided informed consent. Data were systematically gathered using a specific template that included demographic information, disease stage, death, and survival time. Statistical analysis involved descriptive methods, ANOVA, and chi-square tests to assess differences in survival time and associations between categorical variables.

RESULTS

The results reveal a decrease in the number of patients diagnosed during the pandemic period (154 vs. 105), which could indicate delays in detection. However, there were no significant differences between the two periods, in which more than 60% of cases were detected in stage IV, being incompatible with survival. Although fewer patients died during the pandemic than expected (p = 0.015), patients diagnosed after the onset of the pandemic had a shorter survival time (182.43 ± 142.63 vs. 253.61 ± 224.30; p = 0.038). Specifically, those diagnosed in stage I during the pre-pandemic had a much longer survival time (741.50 days) than the rest of the patients (p < 0.05). In addition, among those diagnosed in stage IV, those diagnosed after the beginning of the pandemic had a shorter survival time (157.29 ± 202.36 vs. 241.18 ± 218.36; p = 0.026).

CONCLUSIONS

Understanding these changes can support both medical strategies and non-pharmacological therapies to improve cancer care management during health crises, thus contributing to the optimization of public health.

Demographic Analysis of Cancer Research Priorities and Treatment Correlations

Understanding the diversity in cancer research priorities and the correlations among different treatment modalities is essential to address the evolving landscape of oncology. This study, conducted in collaboration with the European Cancer Patient Coalition (ECPC) and Childhood Cancer International-Europe (CCI-E) as part of the "UNCAN.eu" initiative, analyzed data from a comprehensive survey to explore the complex interplay of demographics, time since cancer diagnosis, and types of treatments received. Demographic analysis revealed intriguing trends, highlighting the importance of tailoring cancer research efforts to specific age groups and genders. Individuals aged 45-69 exhibited highly aligned research priorities, emphasizing the need to address the unique concerns of middle-aged and older populations. In contrast, patients over 70 years demonstrated a divergence in research priorities, underscoring the importance of recognising the distinct needs of older individuals in cancer research. The analysis of correlations among different types of cancer treatments underscored the multidisciplinary approach to cancer care, with surgery, radiotherapy, chemotherapy, precision therapy, and biological therapies playing integral roles. These findings support the need for personalized and combined treatment strategies to achieve optimal outcomes. In conclusion, this study provides valuable insights into the complexity of cancer research priorities and treatment correlations in a European context. It emphasizes the importance of a multifaceted, patient-centred approach to cancer research and treatment, highlighting the need for ongoing support, adaptation, and collaboration to address the ever-changing landscape of oncology.