Diagnosis, treatment, and outcome of patients with oesophagogastric cancer during the COVID-19 pandemic: national study

Abstract

Background The national response to COVID-19 has had a significant impact on cancer services. This study investigated the effect of national lockdown on diagnosis, management, and outcomes of patients with oesophagogastric cancers in Scotland. Methods This retrospective cohort study included consecutive new patients presenting to regional oesophagogastric cancer multidisciplinary teams in National Health Service Scotland between October 2019 and September 2020. The study interval was divided into before and after lockdown, based on the first UK national lockdown. Electronic health records were reviewed and results compared. Results Some 958 patients with biopsy-proven oesophagogastric cancer in 3 cancer networks were included: 506 (52.8 per cent) before and 452 (47.2 per cent) after lockdown. Median age was 72 (range 25–95) years and 630 patients (65.7 per cent) were men. There were 693 oesophageal (72.3 per cent) and 265 gastric (27.7 per cent) cancers. Median time to gastroscopy was 15 (range 0–337) days before versus 19 (0–261) days after lockdown (P < 0.001). Patients were more likely to present as an emergency after lockdown (8.5 per cent before versus 12.4 per cent after lockdown; P = 0.005), had poorer Eastern Cooperative Oncology group performance status, were more symptomatic, and presented with a higher stage of disease (stage IV: 49.8 per cent before versus 58.8 per cent after lockdown; P = 0.04). There was a shift to treatment with non-curative intent (64.6 per cent before versus 77.4 per cent after lockdown; P < 0.001). Median overall survival was 9.9 (95 per cent c.i. 8.7 to 11.4) months before and 6.9 (5.9 to 8.3) months after lockdown (HR 1.26, 95 per cent c.i. 1.09 to 1.46; P = 0.002). Conclusion This national study has highlighted the adverse impact of COVID-19 on oesophagogastric cancer outcomes in Scotland. Patients presented with more advanced disease and a shift towards treatment with non-curative intent was observed, with a subsequent negative impact on overall survival.

Measuring the impact of COVID-19 on cancer survival using an interrupted time series analysis

“…Survival in the United Kingdom was lower for pancreatic ductal adenocarcinoma, although the relationship was not statistically different when adjusted for control variables ( 5 ). Survival for esophagogastric cancer was lower in Scotland but was not statistically different when adjusted for control variables ( 1 ). This highlights the importance of adjusting for stage at diagnosis when examining survival.…”

“…Several studies have investigated the impact of the COVID-19 pandemic on cancer survival ( 1-5 ). Most focused on 1 cancer site, and all included prepost comparisons.…”

A comprehensive summary of the impact of the COVID era on various gastrointestinal cancers

“…Overall survival was 9.9 months before the lockdown and 6.9 months after, significantly worse post-lockdown. 5 It is speculated that this was due to delayed examinations during the lockdown, leading to esophageal cancer being detected at more advanced stages. However, reports from Japan indicated similar (not inferior) outcomes to pre-COVID times, despite limited medical resources.…”

“…Esophageal Cancer: In the UK, diagnoses, management, and outcomes of esophageal cancer were investigated before and after the COVID‐19 lockdown. Overall survival was 9.9 months before the lockdown and 6.9 months after, significantly worse post‐lockdown 5 . It is speculated that this was due to delayed examinations during the lockdown, leading to esophageal cancer being detected at more advanced stages.…”