No changes in clinical presentation, treatment strategies and survival of pancreatic cancer cases during the SARS‐COV‐2 outbreak: A retrospective multicenter cohort study on real‐world data

Abstract

The SARS‐COV‐2 pandemic disrupted healthcare systems. We assessed its impact on the presentation, care trajectories and outcomes of new pancreatic cancers (PCs) in the Paris area. We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP‐HP). We identified all patients newly referred with a PC between January 1, 2019, and June 30, 2021, and excluded endocrine tumors. Using claims data and health records, we analyzed the timeline of care trajectories, the initial tumor stage, the treatment categories: pancreatectomy, exclusive systemic therapy or exclusive best supportive care (BSC). We calculated patients' 1‐year overall survival (OS) and compared indicators in 2019 and 2020 to 2021. We included 2335 patients. Referral fell by 29% during the first lockdown. The median time from biopsy and from first MDM to treatment were 25 days (16‐50) and 21 days (11‐40), respectively. Between 2019 and 2020 to 2021, the rate of metastatic tumors (36% vs 33%, P = .39), the pTNM distribution of the 464 cases with upfront tumor resection (P = .80), and the proportion of treatment categories did not vary: tumor resection (32% vs 33%), exclusive systemic therapy (49% vs 49%), exclusive BSC (19% vs 19%). The 1‐year OS rates in 2019 vs 2020 to 2021 were 92% vs 89% (aHR = 1.42; 95% CI, 0.82‐2.48), 52% vs 56% (aHR = 0.88; 95% CI, 0.73‐1.08), 13% vs 10% (aHR = 1.00; 95% CI, 0.78‐1.25), in the treatment categories, respectively. Despite an initial decrease in the number of new PCs, we did not observe any stage shift. OS did not vary significantly.

Global Burden of Pancreatic Cancer Attributable to High Body-Mass Index in 204 Countries and Territories, 1990–2019

“…A comparative mortality study covering 28 countries of the European Union predicted that pancreatic cancer will surpass breast cancer by 2025 (there will be more deaths from pancreatic cancer than from breast cancer, while the number of pancreatic cancer deaths will increase by 25%), whereby pancreatic cancer will be the third leading cause of cancer death by 2025 (after lung cancer and colorectal cancer) [5]. It remains a question of what effect the COVID-19 pandemic will have on the burden of pancreatic cancer, since previous findings were not consistent: while the findings of a retrospective multicenter cohort study showed that there were no changes in clinical presentation, treatment strategies and survival of pancreatic cancer during the SARS-CoV-2 outbreak [6], some studies reported an increase in tumors localized in the tail of the pancreas and that patients presented with much greater advancement of the disease in 2020 compared to 2019 [7], and that a delay of only 3 months for surgery in stage II or III pancreatic cancer was associated with an over 17% reduction in long-term survival [8].…”