1
|
Agulnik J, Kasymjanova G, Pepe C, Friedmann J, Small D, Sakr L, Wang H, Spatz A, Sultanem K, Cohen V. Real-World Evidence of the Impact of the COVID-19 Pandemic on Lung Cancer Survival: Canadian Perspective. Curr Oncol 2024; 31:1562-1571. [PMID: 38534952 PMCID: PMC10969224 DOI: 10.3390/curroncol31030119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The effect of COVID-19 on treatment outcomes in the literature remains limited and is mostly reported either as predictive survival using prioritization and modeling techniques. We aimed to quantify the effect of COVID-19 on lung cancer survival using real-world data collected at the Jewish General Hospital, Montreal. Methods: This is a retrospective chart review study of patients diagnosed between March 2019 and March 2022. We compared three cohorts: pre-COVID-19, and 1st and 2nd year of the pandemic. Results: 417 patients were diagnosed and treated with lung cancer at our centre: 130 in 2019, 103 in 2020 and 184 in 2021. Although the proportion of advanced/metastatic-stage lung cancer remained the same, there was a significant increase in the late-stage presentation during the pandemic. The proportion of M1c (multiple extrathoracic sites) cases in 2020 and 2021 was 57% and 51%, respectively, compared to 31% in 2019 (p < 0.05). Median survival for early stages of lung cancer was similar in the three cohorts. However, patients diagnosed in the M1c stage had a significantly increased risk of death. The 6-month mortality rate was 53% in 2021 compared to 47% in 2020 and 29% in 2019 (p = 0.004). The median survival in this subgroup of patients decreased significantly from 13 months in 2019 to 6 months in 2020 and 5 months in 2021 (p < 0.001). Conclusions: This study is, to our knowledge, the largest single-institution study in Canada looking at lung cancer survival during the COVID-19 pandemic. Our study looks at overall survival in the advanced/metastatic setting of NSCLC during the COVID-19 pandemic. We have previously reported on treatment pattern changes and increased wait times for NSCLC patients during the pandemic. In this study, we report that the advanced/metastatic subgroup had both an increase in the 6-month mortality rate and worsening overall survival during this same time period. Although there was no statistical difference in the proportion of patients with advanced disease, there was a concerning trend of increased M1c disease in cohorts 2 and 3. The higher M1c disease during the COVID-19 pandemic (cohorts 2 and 3) likely played a crucial role in increasing the 6-month mortality rate and leading to a reduced overall survival of lung cancer patients during the pandemic. These findings are more likely to be better identified with longer follow-up.
Collapse
Affiliation(s)
- Jason Agulnik
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.F.); (V.C.)
| | - Goulnar Kasymjanova
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Carmela Pepe
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Jennifer Friedmann
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.F.); (V.C.)
| | - David Small
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Lama Sakr
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Hangjun Wang
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (H.W.); (A.S.)
| | - Alan Spatz
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (H.W.); (A.S.)
| | - Khalil Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada;
| | - Victor Cohen
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.F.); (V.C.)
| |
Collapse
|
2
|
Strang P, Schultz T. Dying with Cancer and COVID-19, with Special Reference to Lung Cancer: Frailty as a Risk Factor. Cancers (Basel) 2022; 14:cancers14236002. [PMID: 36497483 PMCID: PMC9740004 DOI: 10.3390/cancers14236002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Older age and frailty have been associated with COVID-19 deaths, but frailty has seldom been studied in the context of cancer. The aim of this paper was therefore to study frailty (measured using the Hospital Frailty Risk Score) and other risk factors in patients who died with advanced cancer and a concomitant COVID-19 infection, with special reference to lung cancer. Of 4312 patients who died with cancer, 282 had concomitant COVID-19 (within the last 30 days), and these patients were significantly older, more often men, and residents of nursing homes. They often had less access to specialized palliative care, and they died more often in acute hospital settings. Patients with cancer who died with COVID-19 were more often frail (57% vs. 45%, p = 0.0002), and frailty was independently associated with COVID-19-related deaths, both in univariable and multivariable regression models, as well as when controlling for age, sex, socioeconomic factors on an area level, and comorbidity (measured using the Charlson Comorbidity Index). In the final multivariable model, where patients with cancer who died in nursing homes were excluded, belonging to the high-risk frailty group (OR 2.07 (1.31-3.27), p = 0.002) was the strongest prognostic variable in the model. In a separate analysis of a subgroup of deaths due to lung cancer (n = 653, of which 45 deaths occurred with concomitant COVID-19), the above associations were not significant, possibly due to too-few cases. In conclusion, frailty is a strong predictor of cancer deaths and should be addressed in cancer care.
Collapse
Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm’s Sjukhem Foundation (SSH), Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Research and Development Department, Stockholm’s Sjukhem Foundation (SSH), Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Correspondence:
| | - Torbjörn Schultz
- Research and Development Department, Stockholm’s Sjukhem Foundation (SSH), Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
| |
Collapse
|