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The COVID-19 pandemic poses a challenge to health systems worldwide. Limiting healthcare availability may delay early diagnosis and worsen the treatment effects of various diseases, including oncological diseases. We analyzed patients presenting to the 2nd Department of Lung Diseases and Tuberculosis in Białystok, Poland, with suspicion of lung cancer 12 months prior to the COVID-19 pandemic (pre-COVID-19) and, similarly, 12 months after the outbreak of the pandemic (mid-COVID). In total, 320 patients were analyzed—132 prior to and 188 after the COVID-19 outbreak. During the COVID-19 period, there was a lower percentage of patients presenting with ECOG performance status 0-1, with a noticeably increased percentage of patients with ECOG PS ≥2. The disease’s clinical stage (CS) was higher on admission during COVID-19. We observed more use of immunotherapy and more deaths before the start of treatment during the COVID-19 period. These results provide insight into the early effects of the COVID-19 pandemic on lung cancer patients and underscore the importance of conducting further studies to assess the long-term effects of the COVID-19 pandemic on this population.

Introduction. The diagnosis of lung cancer may still be difficult due to the fact that the first symptoms very often mimic symptoms of other diseases. Case Presentation. In this paper we present two cases, in which initial diagnosis of neuroinfection delayed proper diagnosis. Conclusion. Based on our experience we concluded that neurological symptoms in the area endemic for tick-borne diseases suggesting neuroinfection require careful differential diagnosis. Moreover, neurological symptoms in heavy smokers may be associated with metastases of lung cancer.

Patient: Female, 75-year-old Final Diagnosis: Small cell lung cancer Symptoms: Hemoptysis Medication:— Clinical Procedure: — Specialty: Pulmonology Objective: Unusual clinical course Background : Atezolizumab is an immune checkpoint inhibitor used as first-line treatment with carboplatin and etoposide chemotherapy for advanced small cell lung cancer. Immunochemotherapy treatment decisions can be affected by patients’ physical ability. Because of the exclusion of patients with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2 from clinical trials, treatment outcome evidence in this group is limited. Case Report: We present the case of a 75-year-old woman with an ECOG PS of 2 admitted with respiratory symptoms and diagnosed with advanced small-cell lung cancer. After managing exacerbation of COPD and decompensated heart failure, atezolizumab with carboplatin and etoposide was administered. After 2 cycles of immunochemo-therapy, deterioration of health was observed, including anemia and thrombocytopenia. Because of the good response in imaging tests and restored balance of the patient condition, immunochemotherapy was continued. After 4 cycles of combined treatment, complete regression was achieved. No another adverse effects were observed. The patient was qualified for maintenance therapy with atezolizumab. In follow-up CT scan after 2 cycles of atezolizumab, progression was observed and patient was qualified for second-line treatment. Conclusions: This report presents the case of an older patient with advanced small cell lung cancer and an ECOG status of 2 who responded to combined immunochemotherapy with atezolizumab, etoposide, and carboplatin. Adverse effects observed during immunotherapy were not a reason for discontinuation of the therapy. The assessment of the effectiveness of immunotherapy in patients with ECOG PS ≥2 is difficult owing to the insufficient representation of this group in clinical trials.

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Ewing's sarcoma is a rare and extremely aggressive neoplasm with a tendency to recur even after radical surgery and a tendency to early metastasis. This cancer is characteristic of the pediatric population because the peak incidence of this type of cancer occurs in patients between 10 and 20 years of age, but about 30% of cases occur in older patients. We present a case of Ewing's sarcoma in a 58year-old man with a foot tumor manifestation with a history of back and left leg pain. Due to a lung tumor in the chest X-ray, the patient was referred to the Pulmonology Department, however, the diagnosis was postponed for many months, which in the case of an aggressive tumor, such as Ewing's sarcoma, significantly worsened the initially unfavorable prognosis. The COVID-19 pandemic is having a strong impact on the healthcare systems of countries around the world. Reorganizing medical care and focusing on the pandemic has an impact on the diagnosis and treatment of other diseases. In the current situation, we observe an increase in the number of patients presenting at an advanced stage of the disease, which excludes the possibility of radical treatment. Fear of infection causes both patients to avoid diagnosing disease by focusing on acute symptomatic treatment. The discussed case shows the possible impact of the epidemiological situation of the COVID19 pandemic on the diagnosis and treatment of oncology.