Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area

Abstract

Background Patients affected by HCC represent a vulnerable population during the COVID-19 pandemic and may suffer from the unusual allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of HCC patients within six French referral centers of the metropolitan area of Paris. Materials and methods We performed a multicenter, retrospective, cross-sectional study on the management of patients affected by HCC during the first six weeks of COVID-19 pandemic (exposed), compared to the same period in 2019 (unexposed). Were included all patients discussed in multidisciplinary tumor meeting (MTB) and/or undergoing radiological or surgical programmed procedure during the study period, in a curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treatment. Results After screening, n=670 patients were included (n=293 Exposed to COVID, n=377 Unexposed to COVID). A decrease of the numbers of patients with HCC presented in MTB in 2020 (p=0.034) and with a first diagnosis of HCC (n=104 Exposed to COVID, n=143 Unexposed to COVID, p=0.083) was find. Modification in the treatment strategy was observed in 13.1% of patients, with no differences between the two periods. Nevertheless 21.5% versus 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared to 2019 (p<0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) were hospitalized, and 4 (19.1%) died. Conclusions In a metropolitan area highly impacted by COVID-19 pandemic, we observed a decreased number of cases of HCC, and similar rates of modification in treatment strategy, but with a treatment delay significantly longer in 2020 versus 2019.

COVID-19 and liver disease: mechanistic and clinical perspectives

“…The proper management of HCC requires input from hepatologists, surgeons, intervention radiologists, oncologists and allied health workers, and therefore the maintenance of multidisciplinary care via telemedicine should be actively pursued. However, a multicentre study within the metropolitan area of Paris, France, during a period of high SARS-CoV-2 infection prevalence demonstrated a statistically significant reduction in the number of HCC diagnoses and double the rate of HCC treatment delay compared with the same period the previous year 152 . Nevertheless, the HCC treatment modality, including liver surgery, remained unchanged between the two time periods.…”

The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination

“…Particularly, in countries with widespread community transmission of COVID-19, the pandemic forced an abrupt change in how (and in what form) cancer services were delivered to patients [1] . Understandably, international reports on the impact of COVID-19 on access to and through cancer services have been framed within the experience of systems that are dealing with a major COVID-19 morbidity and mortality burden [2][3][4][5] . These reports have illustrated the likelihood that, in a system stretched by the health response to the pandemic, treatment delays appear inexorable and the consequent impact on mortality appears to be stark [3 , 5-12] .…”

Assessing the impact of COVID-19 on liver cancer management (CERO-19)

“…Even in the absence of these significant complications in liver cancer (LC) patients infected with SARS-CoV-2, treatments have been suspended or delayed, in line with national or institutional policies. As an example, Amaddeo et al have described how LC care changed in the metropolitan area of Paris alongside with the evolution of the COVID-19 pandemic[ 5 ].…”