Changes in lung cancer staging and emergency presentations during the first year of the COVID-19 pandemic

Abstract

Aim: This study retrospectively analyses the impact of the 1st year of the COVID-19 pandemic on route of presentation and staging in lung cancer compared to the 2 years before and after implementation of the Leicester Optimal Lung Cancer Pathway (LOLCP) in Leicester, United Kingdom. Method: Electronic databases and hospital records were used to identify all patients diagnosed with lung cancer in 2018 (pre-LOLCP), 2019 (post-LOLCP), and March 2020–2021 (post-COVID-19 lockdown). Information regarding patient characteristics, performance status, stage, and route of diagnosis was documented and analysed. Emergency presentation was defined as diagnosis of new lung cancer being made after unscheduled attendance to urgent or emergency care facility. Results: Following implementation of the LOLCP pathway, there was a significant decrease in emergency presentations from 26.8 to 19.6% ( p = 0.002) with a stage shift from 33.9% early stage disease to 40.3%. These improved outcomes were annulled during the COVID-19 pandemic, with emergency presentations increasing to 38.9% ( p < 0.001) and a reduction in early-stage lung cancer diagnoses to 31.5%. There was a 61% decline in 2 week wait referrals but no significant decline in the LOLCP direct-to-CT referrals. Conclusion: We have demonstrated a significant increase in late-stage lung cancer diagnoses and emergency presentations during the first year of the COVID-19 pandemic. The causes for these changes are likely to be multifactorial. The long-term effect on lung cancer mortality remains to be seen and is an important focus of future study.

Impact of the COVID‐19 pandemic on international cutaneous squamous cell carcinoma incidence: A systematic review and meta‐analysis

“…By contrast most cancers, of any type, had been reported as having lower incidence rates in 2020. 40 , 41 The presentation of cSCC is rapid in onset and often painful therefore diagnosing most cases of cSCC either face‐to‐face or via telemedicine is not challenging for experienced clinicians. Delayed presentation during the pandemic may have been less likely for cSCC than for other cancers with less obvious visual or sensory impact resulting in a lower threshold for seeking urgent medical attention.…”