Newly diagnosed cancer and the COVID-19 pandemic: tumour stage migration and higher early mortality

Abstract

BackgroundWe compared the new outpatient clinic referrals during the first 10 months of the COVID-19 pandemic with the year before.MethodsWe compared baseline characteristics of the 2208 new referrals in 2020 (n=922) and 2019 (n=1286) with Χ2 and Mann-Whitney U tests and calculated ORs with binary logistic regression. To evaluate the expected changes in the cancer survival secondary to stage migration, we used the 5-year survival data of Survival, Epidemiology and End Results (SEER) Program 2010–2016.ResultsThe percentage of patients with inoperable or metastatic disease was significantly increased during the pandemic (49.8% vs 39%, OR: 1.553, 95% CI: 1.309 to 1.843, p<0.001). We observed a significant decrease in the percentage of patients diagnosed via the screening methods (18.8% vs 28.7%, OR: 1.698, 95% CI: 1.240 to 2.325, p=0.001). The 90-day mortality after the cancer diagnosis was significantly higher during the pandemic (10.5% vs 6.6%, OR: 1.661, 95% CI: 1.225 to 2.252, p=0.001). Due to the increased advanced-stage disease rate at first referral, significant decreases in 5-year survival rates were expected for breast cancer (−8.9%), colorectal cancer (−11.1%), cervix cancer (−10.3%) and melanoma (−7%).ConclusionWe think that collaborative efforts are paramount to prevent the pandemic of late cancer diagnoses and ensure patient safety during the pandemic.

Outcomes and Risk Factors of Patients With COVID-19 and Cancer (ONCORONA): Findings from The Philippine CORONA Study

“…A study showed that there were more patients seen during the pandemic that presented to have inoperable or metastatic cancer (49.8% vs 39%). This meant poorer prognosis and that these patients most likely would only warrant palliative care (chemotherapy and/or radiotherapy) instead of being seen at an earlier stage or less extensive disease in which curative treatment (surgery, chemotherapy, and/or radiotherapy) maybe be offered ( 23 ). The 90-day mortality after the diagnosis of cancer was also higher during the pandemic at 10.5% vs 6.6%.…”

“…The 90-day mortality after the diagnosis of cancer was also higher during the pandemic at 10.5% vs 6.6%. The reason cited in the study was the higher rate of advanced disease at first referral/diagnosis which was attributed to the indirect effect of the pandemic from the lockdowns and logistical limitations for patients to seek consult and have work-up done ( 23 ). Another study supported the findings of the study cited earlier wherein, as compared to the pre-pandemic times, the diagnosis of the six most common types of cancers were lesser ( 24 ).…”

Impact of the COVID-19 Pandemic on the Diagnosis and Prognosis of Melanoma

“…Thus, some Spanish authors have estimated a reduction in survival at 5 years of 1.9% and at 10 years of 2.4% in those melanomas whose diagnosis is delayed by 3 months [ 33 ]. In this line, a recent study estimates a 7% reduction in survival rates in patients with melanoma diagnosed after March 2020 [ 34 ]. These results are only an initial estimation of the possible effect of the outbreak on the survival of patients with melanoma, and large global melanoma registries will have to show the real effect of the pandemic on long-term survival.…”

Immunogenicity of two doses of inactive COVID‐19 vaccine and third booster dose mRNA vaccine in patients with cancer receiving active systemic therapy

“…Mortality and morbidity of COVID‐19 are high secondary to immunocompromise by cancer itself and anti‐cancer treatments. 6 , 20 , 21 , 22 This immunocompromise also affects antibody responses to vaccination. Furthermore, two recent meta‐analyses demonstrated significantly diminished antibody responses in patients receiving active treatment, especially in patients treated with chemotherapy, pointing out the importance of iatrogenic immunosuppression by anti‐cancer treatments and rendering the patients under active anti‐cancer treatment a specific high‐risk group for reduced antibody response to vaccination.…”

“… 5 In addition, the effects of cancer care disruptions during the pandemic are currently better appraised and will most likely have short‐ and long‐term untoward consequences. 6 …”