Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario

Abstract

Introduction Coronavirus disease 2019 (COVID-19) has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak impacted on access to cancer diagnosis and treatment for LC pts compared to pre-pandemic time. Methods Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared to the same period in 2019. Differences between the two years were analyzed using chi-square test for categorical variables and Mann-Whitney U test for continuous variables. Results A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 vs 1637, p=0.09). Newly LC pts in 2020 were more likely to be diagnosed with stage IV disease (p<0.01) and to be current smokers (p<0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% vs -3.2%) compared to the other months included. More LC pts referred to low/medium volume hospital in 2020 compared to 2019 (p=0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (p=0.94), symptoms onset and cytohistological diagnosis (p=0.92), symptoms onset and treatment start (p=0.40), treatment start and first radiological revaluation (p=0.36). Conclusions Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

“…A limitation of our study is the inclusion of a small number of patients from a single hospital. Although a study in Italy showed no significant delays from the onset of symptoms to diagnosis or treatment, 7 it was difficult to conclude whether the results of this study have implications for other areas or countries because there are substantial differences in the severity of the pandemic and in medical systems between countries. Further studies involving a larger number of patients in multiple hospitals are needed to confirm diagnostic and treatment delays resulting from the COVID-19 pandemic.…”

“… 5 However, a slight reduction was observed in the number of newly diagnosed lung cancer cases during the pandemic in Italy. 7 One possibility for this difference could be the differential magnitude of pandemic cases between countries. However, it was difficult to explain why the number of patients with SCLC was higher during the pandemic compared with the pre-pandemic period, in our study.…”

Rising incidence of late stage breast cancer after COVID-19 outbreak. Real-world data from the Italian COVID-DELAY study

“…Nevertheless, as a multicenter study carried out from a broad national collaboration [39], it reflects the heterogeneous response to COVID-19 across different levels, including pandemic geographic distribution and local governments' crisis management. More significantly, previous investigations were largely conducted through network comparisons at major risk of inadequacies in reporting high-quality and real-time data from electronic records during the immediate crisis response [40,41].…”

COVID‐19 outbreak in Lombardy: Impact on reducing solid cancer diagnoses in 2020

“… 8 A slight reduction in newly diagnosed lung cancer cases was observed in 2020 compared to 2019 in several other studies. 28 , 29 , 30 , 31 However, some studies have observed relevant decrease in lung cancer diagnoses 32 , 33 likely due to the disruption of lung cancer screening 34 , 35 , 36 or to the different setting of the study (hospital vs population‐based). Lung cancer screening is not available in Italy.…”