Impact of the COVID-19 Pandemic on Treatment and Oncologic Outcomes for Cancer Patients in Romania

Abstract

Background/Aim: This study aimed to assess the impact of the ongoing COVID-19 pandemic on cancer patients, known to be immune-compromised due to the disease itself, oncological treatments and adjuvant medicines use such as steroids. Overall survival was determined for patients with COVID-19 infection and stratification according to known comorbidities and complications was performed. Patients and Methods: This prospective study included ninety cancer patients with COVID-19 confirmed by PCR testing performed before each cycle of chemotherapy or every two weeks during radiotherapy between May and December 2020 in two tertiary Cancer Centers. Demographic, cancer-related and SARS-CoV-2 infection data were collected and long-term oncologic outcome was assessed. Results: Mean age of cancer patients diagnosed with SARS-CoV-2 was 59.7±12.1 years (range=30-83 years). Fifty-two (57.7%) were women. The most frequent cancer localization was breast (n=28, 31.1%) followed by colorectal (n=11, 12.2%) and lung cancer (n=8, 8.8%). Most patients infected with SARS-CoV-2 were diagnosed in stage IV of the disease (n=44, 48.9%) followed by stage III (n=19, 21.1%) and stage II disease (18.9%). Regarding comorbidities, the most common was hypertension (n=31) followed by cardiac dysfunction (n=23) and type II diabetes (n=13). Of 27 (30%) patients who needed hospitalization, 4 patients developed severe infection, 17 patients had mild symptoms and 6 patients were minimally symptomatic. After a median follow-up of 22.5 months, 5 patients (5.55%) died due to SARS-COV-2 infection, all stages III and IV. Median estimated overall survival was 14 months in patients who died because of COVID infection compared to 98 months in cancer-related mortality analysis (p<0.0001). Three deaths occurred during chemotherapy, 1 death in the chemoradiotherapy radiotherapy group. Conclusion: SARS-CoV-2 infection was associated with an excess mortality in our study population, especially in patients with advanced and metastatic disease and in those receiving immunosuppressive treatment such as chemotherapy and radiotherapy.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting illness, COVID-19, have emerged as a global pandemic (1). In 2003, the SARS epidemic was correlated with a coronavirus. The new coronavirus (2019-nCoV), first appeared in December 2019 in Wuhan (China) as the perpetuator of severe respiratory infection in humans (2). The World Health Organization (WHO) made the assessment that COVID-19 must be defined and treated as a pandemic in March 2020. The human coronavirus disease COVID-19 became the fifth registered pandemic sequent to the 1918 Spanish flu, 1957 Asian flu, 1968 Hong Kong flu and the 2009 Pandemic flu (3). In September 2021, the total number of confirmed cases of SARS-CoV-2 infection was 229,222,879 worldwide. The total number of deaths allocated to this disease was 4,702,936. Some countries did not compile this data and many recoveries from both confirmed and untested infections remain unregistered. Unfortu...

Inequities in Screening and HPV Vaccination Programs and Their Impact on Cervical Cancer Statistics in Romania

“…During the pandemic years (2020-2022), we saw a reduction in cervical cancer cases that was in parallel with the overall reduction in all cancer cases treated. This was caused by the restrictions imposed during the COVID-19 pandemic and the patients' fear of contracting the SARS-CoV2 virus when being treated for other pathologies, which severely limited the access of patients to treatment and resulted in a huge impact on the treatment and oncologic outcomes for cancer patients [8]. However, the percentage of hospitalization episodes and number of surgical procedures caused by CC out of the total remained the same as during the pre-pandemic years.…”

The Impact of SARS-CoV-2 Pandemic on Patients with Malignant Melanoma at a Romanian Academic Center: A Four-Year Retrospective Analysis

“…An example from Italy, a country that was severely affected by SARS-CoV-2 during the early phases of the pandemic, where approximately 30 thousand cancer patients were analyzed, the highest excess mortality has been predicted in those with melanoma and female genital cancers [ 26 ]. In contrast, there is scant information on the number of missed cases and advanced cancer during the pandemic in less developed countries such as Romania, with the exception of a few monocentric studies or mathematical models that speculated on the possible effects of a lack of diagnostic facilities and missed medical checkups [ 27 , 28 ].…”

Understanding COVID Vaccination and Its Implication in Cancer Patients’ Imaging of Lymph Nodes by PET-CT

“…Since December 2020, Romania registered a vaccination rate of only 41.9%, almost half of the European mean of 72.4% [ 1 ]. Nevertheless, this fact entailed a high rate of mortality among COVID patients, an important percentage of them being cancer patients [ 2 ]. Considering this, various recommendations were made, and robust data on the immune response in actively treated cancer patients are emerging or are being published.…”