Impact of the COVID-19 pandemic on the oncologic activities (diagnosis, treatment, clinical trials enrollment) of a general hospital in a district with high prevalence of SARS-COV-2 in Italy

Abstract

Purpose Little is known about the real impact of the COVID-19 outbreak on the qualitative and quantitative fall-out on the management of cancer patients. Our objective was to provide evidence of the effects of SARS-COV-2 on the management of cancer patients in the real world. Methods In a general hospital in a district in Italy with high prevalence of COVID-19 during the first wave, we retrospectively analyzed the data of oncologic activity, namely new cancer diagnosis, types of treatment (intravenous or by mouth), clinical research studies, and drug utilization, and compared the findings with those of 2019, before the pandemic. The data have been summarized in boxplot figures for median and interquartile range. Results In 2020, a significant reduction in new cancer diagnosis was demonstrated when compared with 2019, with 17.4% fewer cancer diagnoses, 84.5% fewer patients enrolled in clinical trials, a 10.6% reduction in intravenous antitumor treatment, and a 42.7% increase in oral anticancer treatment. Conclusion Our data indicate a significant reduction in cancer diagnosis, antitumor venous treatment, and patients enrolled in clinical research studies in 2020 compared with 2019, although there was a significant increase in oral treatment. These data suggest that the COVID-19 pandemic had a deep impact on the real-world management of cancer patients in a district of Italy with a high prevalence of COVID-19.

Secondary Impact of the Coronavirus Disease 19 Pandemic on Patients and the Cellular Therapy Healthcare Ecosystem

“…In addition, several studies demonstrated a reduction in National Cancer Institute (NCI)-sponsored cancer trials along with overall clinical trial enrollment 43 . Similar reductions in cancer clinical trials were noted worldwide, as one Italian Center saw an 84.5% reduction in patient clinical trial enrollment 42 .…”

“…The COVID-19 pandemic drastically disrupted the conduct and management of cancer patients enrolled in clinical trials. With the onset of the pandemic, centers observed an apparent decline in the numbers of new cancer diagnoses, likely reflecting access to care issues and patient avoidance of care for fear of contracting COVID-19 42 . In addition, several studies demonstrated a reduction in National Cancer Institute (NCI)-sponsored cancer trials along with overall clinical trial enrollment 43 .…”

Bio‐ethical issues in oncology during the first wave of the COVID‐19 epidemic: A qualitative study in a French hospital

“…Unfortunately, the “hydroxychloroquine affair” clearly demonstrated the non‐negligible limitations of this approach in terms of ethics and scientific integrity 80,81 . Priority in healthcare is still given to patients infected with the pandemic microbe, at the expense of everyone else, even when, as seen here, various clinicians and researchers highlight the possible, or even probable, deleterious consequences of this approach in the medium and long term 1,54,82 . The prohibition of visits to hospitalized relatives imposed by national or regional policies and administrations would undoubtedly be repeated, even at the expense of definitively destroying the relationship of trust between oncologists and the family of the cancer patient that is so essential for effective medical practice 83 .…”

“…80,81 Priority in healthcare is still given to patients infected with the pandemic microbe, at the expense of everyone else, even when, as seen here, various clinicians and researchers highlight the possible, or even probable, deleterious consequences of this approach in the medium and long term. 1,54,82 The prohibition of visits to hospitalized relatives imposed by national or regional policies and administrations would undoubtedly be repeated, even at the expense of definitively destroying the relationship of trust between oncologists and the family of the cancer patient that is so essential for effective medical practice. 83 The outcome might be an unsatisfactory quality of life (i.e., happiness) and/or survival rate for cancer patients, as we are currently seeing.…”

Position paper of the Italian Association of Medical Oncology on the impact of COVID-19 on Italian oncology and the path forward: the 2021 Matera statement

“…The containment measures to halt the spread of the COVID-19 infection, the conversion of many oncology in-patient clinics into COVID-19 units (particularly during the first wave of the pandemic and in the regions of northern Italy), the shortage of oncologists and radiotherapists diverted to COVID-19 care, and the lack of ICU beds, occupied by patients with severe acute respiratory syndrome, have contributed significantly to this scenario, albeit with substantial differences between regions. [13][14][15] The consequences of the serious interruption of all aspects of the cancer care continuum, from screening to treatment, will potentially result in an increase in advanced-stage cancer diagnoses in the coming years and may lead to an increase in cancerrelated mortality. 16 Social isolation and anxiety due to delayed (or impeded) access to diagnosis, surgery, or systemic treatments have also affected mental well-being of patients with cancer, their caregivers, and cancer survivors.…”