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      Lung Cancer Stage Shift as a Result of COVID-19 Lockdowns in New York City, a Brief Report

      discussion
      Author(s): a , * , b , b , a , a , a , a , a , b , b , a
      Publication date (Electronic):
      Journal: Clinical Lung Cancer
      Publisher: Elsevier Inc.
      Keywords: Pandemic, SARS-CoV-2, Cancer Care Delays, Thoracic Oncology, Stage Shift, COVID-19, Coronavirus Disease 2019, NSCLC, non-small cell lung cancer, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2, WHO, World Health Organization, ANOVA, analysis of variance, CCI, Charlson Comorbidity Index, Q, Quarter, CMS, Centers for Medicare and Medicaid Services, ECOG, Eastern Cooperative Oncology Group Performance Status, CT, computed tomography, VDT, Volume-Doubling Time, SEER, Surveillance, Epidemiology and End Results Database

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          Abstract

          Introduction

          : The COVID-19 pandemic reached New York City in early March 2020 resulting in an 11-week lockdown period to mitigate further spread. It has been well documented that cancer care was drastically affected as a result. Given New York City's early involvement, we attempted to identify any stage shift that may have occurred in the diagnoses of non-small cell lung cancer (NSCLC) at our institution as a result of these lockdowns.

          Methods

          : We conducted a retrospective review of a prospective database of lung cancer patients at our institution from July 1 st, 2019 until March 31 st, 2021. Patients were grouped by calendar year quarter in which they received care. Basic demographics and clinical staging were compared across quarters.

          Results

          : 554 patients were identified that underwent treatment during the time period of interest. During the lockdown period, there was a 50% reduction in the mean number of patients seen (15 ± 3 vs 28 ± 7, p=0.004). In the quarter following easing of restrictions, there was a significant trend towards earlier stage (cStage I/II) disease. In comparison to quarters preceding the pandemic lockdown, there was a significant increase in the proportion of patients with Stage IV disease in the quarters following phased reopening (p=0.026).

          Conclusions

          : After a transient but significant increase in Stage I/II disease with easing of restriction there was a significant increase in patients with Stage IV disease. Extended longitudinal studies must be conducted to determine whether COVID-19 lockdowns will lead to further increases in the proportion of patients with advanced NSCLC.

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

            Camille Maringe, James Spicer, Melanie Morris … (2020)
            Summary Background Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types. Methods In this national population-based modelling study, we used linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15–84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1, 2010, and Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, 2012, and Dec 31, 2012, with follow-up data until Dec 31, 2015. We use a routes-to-diagnosis framework to estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. To model the subsequent impact of diagnostic delays on survival, we reallocated patients who were on screening and routine referral pathways to urgent and emergency pathways that are associated with more advanced stage of disease at diagnosis. We considered three reallocation scenarios representing the best to worst case scenarios and reflect actual changes in the diagnostic pathway being seen in the NHS, as of March 16, 2020, and estimated the impact on net survival at 1, 3, and 5 years after diagnosis to calculate the additional deaths that can be attributed to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data. Findings We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. Across the three different scenarios, compared with pre-pandemic figures, we estimate a 7·9–9·6% increase in the number of deaths due to breast cancer up to year 5 after diagnosis, corresponding to between 281 (95% CI 266–295) and 344 (329–358) additional deaths. For colorectal cancer, we estimate 1445 (1392–1591) to 1563 (1534–1592) additional deaths, a 15·3–16·6% increase; for lung cancer, 1235 (1220–1254) to 1372 (1343–1401) additional deaths, a 4·8–5·3% increase; and for oesophageal cancer, 330 (324–335) to 342 (336–348) additional deaths, 5·8–6·0% increase up to 5 years after diagnosis. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204–63 229 years. Interpretation Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer. Funding UK Research and Innovation Economic and Social Research Council.
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              Mortality due to cancer treatment delay: systematic review and meta-analysis

              Timothy Hanna, Will King, Stephane Thibodeau … (2020)
              Abstract Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. Design Systematic review and meta-analysis. Data sources Published studies in Medline from 1 January 2000 to 10 April 2020. Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models. Results The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings. Conclusions Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Lung Cancer
                Journal ID (iso-abbrev): Clin Lung Cancer
                Title: Clinical Lung Cancer
                Publisher: Elsevier Inc.
                ISSN (Print): 1525-7304
                ISSN (Electronic): 1938-0690
                Publication date PMC-release: 29 August 2021
                Publication date (Electronic): 29 August 2021
                Affiliations
                [a ]Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68 th St, M-404 New York, NY 10065
                [b ]Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, 525 E 68 th St, Box 130 New York, NY 10065
                Author notes
                [* ]Corresponding author. Department of Cardiothoracic Surgery, 525 E 68th St, M-404, New York, NY 10065
                Article
                Publisher Item ID: S1525-7304(21)00214-X
                DOI: 10.1016/j.cllc.2021.08.010
                PMC ID: 8403338
                PubMed ID: 34580031
                SO-VID: 347e5e59-65b6-42b4-8546-0b872651dd5c
                Copyright © © 2021 Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 6 August 2021
                Date accepted : 19 August 2021
                Categories
                Subject: Article

                Keywords: pandemic,sars-cov-2,cancer care delays,thoracic oncology,stage shift,covid-19, coronavirus disease 2019,nsclc, non-small cell lung cancer,sars-cov-2, severe acute respiratory syndrome coronavirus 2,who, world health organization,anova, analysis of variance,cci, charlson comorbidity index,q, quarter,cms, centers for medicare and medicaid services,ecog, eastern cooperative oncology group performance status,ct, computed tomography,vdt, volume-doubling time,seer, surveillance, epidemiology and end results database
                Data availability:
                Keywords: pandemic, sars-cov-2, cancer care delays, thoracic oncology, stage shift, covid-19, coronavirus disease 2019, nsclc, non-small cell lung cancer, sars-cov-2, severe acute respiratory syndrome coronavirus 2, who, world health organization, anova, analysis of variance, cci, charlson comorbidity index, q, quarter, cms, centers for medicare and medicaid services, ecog, eastern cooperative oncology group performance status, ct, computed tomography, vdt, volume-doubling time, seer, surveillance, epidemiology and end results database

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