Lung Cancer Stage Shift as a Result of COVID-19 Lockdowns in New York City, a Brief Report

Abstract

Introduction : The COVID-19 pandemic reached New York City in early March 2020 resulting in an 11-week lockdown period to mitigate further spread. It has been well documented that cancer care was drastically affected as a result. Given New York City's early involvement, we attempted to identify any stage shift that may have occurred in the diagnoses of non-small cell lung cancer (NSCLC) at our institution as a result of these lockdowns. Methods : We conducted a retrospective review of a prospective database of lung cancer patients at our institution from July 1 st , 2019 until March 31 st , 2021. Patients were grouped by calendar year quarter in which they received care. Basic demographics and clinical staging were compared across quarters. Results : 554 patients were identified that underwent treatment during the time period of interest. During the lockdown period, there was a 50% reduction in the mean number of patients seen (15 ± 3 vs 28 ± 7, p=0.004). In the quarter following easing of restrictions, there was a significant trend towards earlier stage (cStage I/II) disease. In comparison to quarters preceding the pandemic lockdown, there was a significant increase in the proportion of patients with Stage IV disease in the quarters following phased reopening (p=0.026). Conclusions : After a transient but significant increase in Stage I/II disease with easing of restriction there was a significant increase in patients with Stage IV disease. Extended longitudinal studies must be conducted to determine whether COVID-19 lockdowns will lead to further increases in the proportion of patients with advanced NSCLC.

Shift in lung cancer stage at diagnosis during the COVID-19 pandemic in New York City

“…This descriptive analysis suggests an immediate negative impact on lung cancer diagnoses of COVID-19 restrictions, with a sharp decrease in early stage diagnoses when a “pause” on elective procedures was introduced during the Spring of 2020, as well as when COVID-19 cases sharply increased during the Winter of 2021. Although a lot have been said on the delays in diagnosis and treatment following the COVID-19 pandemic ( 3 - 5 ), few studies have shown how delays affect stage at diagnosis ( 6 ), and those who studied the problem did not apply the sophisticated approach we used. The pandemic affected screening, early detection, and drastically reduced any patient’s contact with the health system that would have prompted an early lung cancer diagnosis.…”

Time intervals in the care pathway to cancer diagnosis during the COVID‐19 pandemic: A large retrospective study from a high‐volume center

“…By investigating the stage distribution of lung cancer in 554 patients between 1 July 2019 and 31 March 2021, a retrospective study at a large hospital in New York found that, in comparison with the distribution in nonpandemic months and the second quarter of 2020, which included the lockdown period, the proportion of stage IV cancers diagnosed during the quarters succeeding gradual resumption (October 2020 to March 2021) increased significantly. 35 Arguably, an apparent stage‐shift was a consequence of lockdown‐related delays and the reported exponential nature of lung cancer growth and time to progression. Interestingly, a recent study analyzing circulating concentrations of tumor DNA in newly diagnosed metastatic colorectal cancer before vs after lockdown in France found that patients diagnosed after it had a greater tumor burden (defined as statistically higher concentrations of tumor DNA) than those diagnosed before, and that the median survival of patients with high tumor DNA concentrations was lower than of those with lower concentrations.…”

“…Some evidence exists on stage‐shift to later‐stage disease due to the pandemic. By investigating the stage distribution of lung cancer in 554 patients between 1 July 2019 and 31 March 2021, a retrospective study at a large hospital in New York found that, in comparison with the distribution in nonpandemic months and the second quarter of 2020, which included the lockdown period, the proportion of stage IV cancers diagnosed during the quarters succeeding gradual resumption (October 2020 to March 2021) increased significantly 35 . Arguably, an apparent stage‐shift was a consequence of lockdown‐related delays and the reported exponential nature of lung cancer growth and time to progression.…”

“…March 2021) increased significantly. 35 Arguably, an apparent stageshift was a consequence of lockdown-related delays and the reported exponential nature of lung cancer growth and time to progression.…”

'And I thought having a cancer diagnosis was hard': A descriptive phenomenological study of family caregiver experiences navigating the pre-hospital system during COVID-19

“…During the lockdown in Shanghai, cancer patients were allowed to have a caregiver accompany them at the emergency department and the bedside during hospitalization. There is increasing evidence about the challenges of accessing health care services during the lockdown ( Topriceanu et al, 2021 ; Mynard et al, 2022 ). Yet, what is unclear is how family caregivers navigate the pre-hospital admissions process aimd strict pandemic control measures and supportive policies for cancer care.…”