Stage migration in newly diagnosed oesophagogastric cancer during the first wave of the COVID-19 pandemic

Khan, Khurram; Gall, Lewis; Dreyer, Stephan; McCollum, Catherine W.; Chuntamongkol, Rongkagorn; Craig, Carol; MacKay, C; Macdonald, Andrew; Forshaw, Matthew

doi:10.1093/bjs/znac112

Cited by 3 publications

(10 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The same staging modalities were unavailable during the pandemic in up to 9.4%, 10.9%, 2.1%, 23.1%, 13.7%, and 23.7% of cases, respectively ( 15 ). Referral delays for diagnostic gastroscopy were also noted in a UK analysis of patients with esophagogastric cancer between 2019–2020 ( 7 ). Additionally, Huang et al noted a 69% decrease in overall endoscopic case volume during the pandemic in China ( 14 ).…”

Section: Resultsmentioning

confidence: 98%

“…There was a 3-month decrease in survival in patients not treated with surgical resection (5 vs. 8 months, P=0.004). In addition to the aforementioned increased rates of acute hospital admissions (28.0% vs. 12.5%, P=0.001) and metastatic disease at presentation (47.8% vs. 33.3%, P=0.008), significantly higher rates of palliative treatment were noted after the lockdown in this patient population (71.3% vs. 55.7%, P=0.003) ( 7 ).…”

Section: Resultsmentioning

confidence: 99%

“…Also, an analysis of patients with esophagogastric cancer between 2019–2020 in the United Kingdom (UK) indicated a significant increase in acute hospital admissions and a decline in urgent clinic referrals after the first government-issued lockdown during the pandemic. After the lockdown, increased metastatic disease at presentation was noted ( 7 ).…”

Section: Resultsmentioning

confidence: 99%

“…As COVID-19 swept across the world, governments were tasked with ensuring the pandemic response had sufficient resources to allow frontline healthcare workers to tackle COVID-19. Unfortunately, the resources for the pandemic response were required to be redirected from other sectors of healthcare and allocated away from patients with stable conditions, such as those undergoing planned oncologic resections ( 5 - 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…In cases of delayed access to care, the prolonged time to diagnosis, and delays in treatment of ECs may have resulted in disease progression prior to treatment initiation which confers worse long-term prognostication for some patients, while precluding others from surgical resection with curative intent ( 5 , 7 ). While it was necessary to allocate resources during the pandemic to the management of the COVID-19 outbreaks, large groups of non-COVID patients may have received suboptimal care as a result ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review

Fialka,

El-Andari,

Jogiat

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

Background The coronavirus disease 2019 (COVID-19) pandemic challenged global infrastructure. Healthcare systems were forced to reallocate resources toward the frontlines. In this systematic review, we analyze the impact of resource reallocation during the COVID-19 pandemic on the diagnosis, management, and outcomes of esophageal cancer (EC) patients. Methods PubMed and Embase were systematically searched for articles investigating the impact of the COVID-19 pandemic on EC patients. Of the 1,722 manuscripts initially screened, 23 met the inclusion criteria. Results Heterogeneity of data and outcomes reporting prohibited aggregate analysis. Reduced detection of EC and considerable variability in disease stage at presentation were noted during the COVID-19 pandemic. EC patients experienced delays in diagnostic and preoperative staging investigations but surgical resection was not associated with greater short-term morbidity or mortality. Modeling the impact of pandemic-related delays in EC care predicts significant reductions in survival with associated economic losses in the coming years. Conclusions Amidst resource scarcity during the COVID-19 pandemic, the multidisciplinary management of patients with EC was affected at multiple stages in the care pathway. Although the complete ramifications of reductions in EC diagnosis and delays in care remain unclear, EC surgery was able to safely continue as a result of collaboration between centers, strict adherence to COVID-19 protective measures, and reallocation of healthcare resources towards the same. Ultimately, when healthcare systems are pushed to the brink, the downstream consequences of resource reallocation require judicious analysis to optimize overall patient outcomes.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review

Fialka,

El-Andari,

Jogiat

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

show abstract

Diagnosis, treatment, and outcome of patients with oesophagogastric cancer during the COVID-19 pandemic: national study

Baxter

Khan

Gall

et al. 2023

British Journal of Surgery

Self Cite

View full text Add to dashboard Cite

Background The national response to COVID-19 has had a significant impact on cancer services. This study investigated the effect of national lockdown on diagnosis, management, and outcomes of patients with oesophagogastric cancers in Scotland. Methods This retrospective cohort study included consecutive new patients presenting to regional oesophagogastric cancer multidisciplinary teams in National Health Service Scotland between October 2019 and September 2020. The study interval was divided into before and after lockdown, based on the first UK national lockdown. Electronic health records were reviewed and results compared. Results Some 958 patients with biopsy-proven oesophagogastric cancer in 3 cancer networks were included: 506 (52.8 per cent) before and 452 (47.2 per cent) after lockdown. Median age was 72 (range 25–95) years and 630 patients (65.7 per cent) were men. There were 693 oesophageal (72.3 per cent) and 265 gastric (27.7 per cent) cancers. Median time to gastroscopy was 15 (range 0–337) days before versus 19 (0–261) days after lockdown (P < 0.001). Patients were more likely to present as an emergency after lockdown (8.5 per cent before versus 12.4 per cent after lockdown; P = 0.005), had poorer Eastern Cooperative Oncology group performance status, were more symptomatic, and presented with a higher stage of disease (stage IV: 49.8 per cent before versus 58.8 per cent after lockdown; P = 0.04). There was a shift to treatment with non-curative intent (64.6 per cent before versus 77.4 per cent after lockdown; P < 0.001). Median overall survival was 9.9 (95 per cent c.i. 8.7 to 11.4) months before and 6.9 (5.9 to 8.3) months after lockdown (HR 1.26, 95 per cent c.i. 1.09 to 1.46; P = 0.002). Conclusion This national study has highlighted the adverse impact of COVID-19 on oesophagogastric cancer outcomes in Scotland. Patients presented with more advanced disease and a shift towards treatment with non-curative intent was observed, with a subsequent negative impact on overall survival.

show abstract

National adoption of an esophageal cell collection device for Barrett’s esophagus surveillance: impact on delay to investigation and pathological findings

Chien,

Glen,

Penman

et al. 2024

Diseases of the Esophagus

View full text Add to dashboard Cite

Summary High quality Barrett’s esophagus surveillance is crucial to detect early neoplastic changes. An esophageal cell collection device (OCCD) was introduced as a triage tool for Barrett’s surveillance. This study aims to evaluate whether the Scottish OCCD program (CytoSCOT) has reduced delays to Barrett’s surveillance, and whether delayed surveillance negatively impacts endoscopic pathology. All patients undergoing OCCD testing for Barrett’s surveillance across 11 Scottish health boards between 14/9/2020 and 13/9/2022 were identified. Patients were dichotomised into two groups (Year 1 vs. Year 2), with individual records interrogated to record demographics, recommended surveillance interval, time from last endoscopy to OCCD test, and OCCD result. Patients were deemed high-risk if the OCCD demonstrated atypia and/or p53 positivity. Further analysis was performed on patients who underwent endoscopy within 12 months of OCCD testing. A total of 3223 OCCD tests were included in the analysis (1478 in Year 1; 1745 in Year 2). In Year 1 versus Year 2, there was a longer median delay to surveillance (9 vs. 5 months; P < 0.001), increased proportion of patients with delayed surveillance (72.6% vs. 57.0%; P < 0.001), and more high-risk patients (12.0% vs. 5.3%; P < 0.001). 425/3223 patients (13.2%) were further investigated with upper gastrointestinal endoscopy, 57.9% of which were high-risk. As surveillance delay increased beyond 24 months, high-risk patients were significantly more likely to develop dysplasia or malignancy (P = 0.004). Delayed Barrett’s esophagus surveillance beyond 24 months is associated with increased risk of pre-cancerous pathology. The CytoSCOT program has reduced delays in surveillance, promoting earlier detection of dysplasia and reducing burden on endoscopy services.

show abstract

Stage migration in newly diagnosed oesophagogastric cancer during the first wave of the COVID-19 pandemic

Abstract: There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.

Cited by 3 publications

References 3 publications

Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review

Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review

Diagnosis, treatment, and outcome of patients with oesophagogastric cancer during the COVID-19 pandemic: national study

National adoption of an esophageal cell collection device for Barrett’s esophagus surveillance: impact on delay to investigation and pathological findings

Contact Info

Product

Resources

About