Stage migration of testicular germ cell tumours in Alberta, Canada, during the COVID-19 pandemic: a retrospective cohort study

Lee‐Ying, Richard M.; O’Sullivan, Dylan E.; Gagnon, Richard; Bosma, Nicholas; Stewart, Robert L.; Railton, Cindy; Tilley, D G; Alimohamed, Nimira; Basappa, Naveen S.; Cheng, Tina; Kolinsky, Michael; Karim, Safiya; Ruether, Dean; North, Scott; Yip, Steven; Danielson, Brita; Heng, Daniel Yick Chin; Brenner, Darren R.

doi:10.9778/cmajo.20210285

Cited by 3 publications

(6 citation statements)

References 42 publications

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“…17 In this study, 7.8% of patients diagnosed before the pandemic presented with stage III disease, which increased to 15.4% during the pandemic. 17 The pandemic initially led to a decline in cases, followed by a significant increase in stage III disease and a decrease in stage II disease. 17 Our study is one of a few assessing testicular cancer staging at presentation during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 53%

“…16 The largest study, conducted in Alberta, Canada, examined 335 patients with germ cell tumours. 17 Their study divided participants by April 2020, the first month with all pandemic restrictions, and covered 15 months before this date and 14 months after. 17 In this study, 7.8% of patients diagnosed before the pandemic presented with stage III disease, which increased to 15.4% during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…17 Their study divided participants by April 2020, the first month with all pandemic restrictions, and covered 15 months before this date and 14 months after. 17 In this study, 7.8% of patients diagnosed before the pandemic presented with stage III disease, which increased to 15.4% during the pandemic. 17 The pandemic initially led to a decline in cases, followed by a significant increase in stage III disease and a decrease in stage II disease.…”

Section: Discussionmentioning

confidence: 99%

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Restricted access and advanced disease in post-pandemic testicular cancer

Fagan,

Janes,

Andrews

et al. 2024

CUAJ

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Introduction: Urologists observed reduced cancer consultations and surgeries during the SARS-CoV-2 pandemic, raising concern about treatment delays. Testicular cancer serves as a particularly sensitive marker of this phenomenon, as the clinical stage of testicular cancer at presentation is predictive of cancer-specific survival. We aimed to investigate whether COVID-related restrictions to primary care access resulted in increased incidence of metastatic germ cell testis cancer. Methods: A retrospective chart review was conducted on all cases of testicular cancer managed surgically at our center from March 1, 2018, to February 28, 2023. Patients were categorized into temporal cohorts, representing before, during, and following the implementation of COVID-19 public health restrictions in the province of Newfoundland and Labrador. Results: Forty-one cases of testicular germ cell tumors were identified during the study period. The mean age at diagnosis was 40.8 years (standard deviation ±13.7). Demographics did not vary across the cohorts. Clinical stage 3 disease remained stable before and during the pandemic at 10.5% and 9.1% of cases, respectively. In the post-pandemic period, there was an increase to 27.3% (p=0.617). Surgical wait times remained stable across the pandemic (p=0.151). Conclusions: There was a 16.8% rise in clinical stage III disease from the pre-pandemic to post-pandemic period. Our study failed to identify a statistically significant increase in metastatic testis cancer incidence upon lifting of pandemic restrictions. Further study is necessary to confirm suspicions that pandemic restrictions contributed to increased incidence of metastatic testis cancer.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Restricted access and advanced disease in post-pandemic testicular cancer

Fagan,

Janes,

Andrews

et al. 2024

CUAJ

View full text Add to dashboard Cite

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“…Owing to the drop in cancer incidence, 21 the demand for cancer therapy was lowered, which, coupled with the large-scale cancelation of elective surgeries, may have preserved capacity within the cancer system for nonsurgical care delivery. 36 If the pandemic has indeed caused a pronounced migration toward more advanced cancer stages at presentation, 28 , 37 this would translate to more patients requiring immediate treatment. We used a conservative definition for “no treatment” by not counting hormonal therapy, which may result in an underestimation for treatment delivered as bridging therapy before definitive treatment, 32 although results of our sensitivity analysis excluding hormone-sensitive cancers suggested this effect to be negligible.…”

Section: Discussionmentioning

confidence: 99%

Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study

Sutradhar

et al. 2023

cmajo

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Background: Physicians were directed to prioritize using nonsurgical cancer treatment at the beginning of the COVID-19 pandemic. We sought to quantify the impact of this policy on the modality of first cancer treatment (surgery, chemotherapy, radiotherapy or no treatment). Methods: In this population-based study using Ontario data from linked administrative databases, we identified adults diagnosed with cancer from January 2016 to November 2020 and their first cancer treatment received within 1 year postdiagnosis. Segmented Poisson regressions were applied to each modality to estimate the change in mean 1-year recipient volume per thousand patients (rate) at the start of the pandemic (the week of Mar. 15, 2020) and change in the weekly trend in rate during the pandemic (Mar. 15, 2020, to Nov. 7, 2020) relative to before the pandemic (Jan. 3, 2016, to Mar. 14, 2020). Results: We included 321 535 people diagnosed with cancer. During the first week of the COVID-19 pandemic, the mean rate of receiving upfront surgery over the next year declined by 9% (rate ratio 0.91, 95% confidence interval [CI] 0.88–0.95), and chemotherapy and radiotherapy rates rose by 30% (rate ratio 1.30, 95% CI 1.23–1.36) and 13% (rate ratio 1.13, 95% CI 1.07–1.19), respectively. Subsequently, the 1-year rate of upfront surgery increased at 0.4% for each week (rate ratio 1.004, 95% CI 1.002–1.006), and chemotherapy and radiotherapy rates decreased by 0.9% (rate ratio 0.991, 95% CI 0.989–0.994) and 0.4% (rate ratio 0.996, 95% CI 0.994–0.998), respectively, per week. Rates of each modality resumed to prepandemic levels at 24–31 weeks into the pandemic. Interpretation: An immediate and sustained increase in use of nonsurgical therapy as the first cancer treatment occurred during the first 8 months of the COVID-19 pandemic in Ontario. Further research is needed to understand the consequences.

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“…[26][27][28][29][30] A recent retrospective Canadian study documented similar findings with a 7.6% increase in stage III disease staging of testicular germ cell tumours throughout the pandemic without assessment of the post-pandemic period. 41 There has been limited reporting regarding pandemic impacts on RCC staging with one Italian study, conducting an annual comparison of RCC from 2018 -2020 finding insignificant differences in staging across this timeframe. Interestingly, the present study showed a 3.5% decrease in the proportion of pT3 RCC diagnosed during the pandemic compared with the pre-pandemic period.…”

Section: Discussionmentioning

confidence: 99%

Impacts of the COVID-19 pandemic on diagnosis of renal cell carcinoma and disease stage at presentation

Janes,

Fagan,

Andrews

et al. 2023

CUAJ

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Introduction: Renal cell carcinoma (RCC) is often associated with significant morbidity and mortality, with overall survival contingent on multiple factors — most importantly, disease stage at diagnosis. Disruptions in healthcare delivery during the COVID-19 pandemic have resulted in various reported diagnostic and treatment delays, which have had detrimental impacts on malignancies such as RCC. Methods: Surgically managed cases of RCC at our center were identified using a retrospective chart review of all nephrectomies conducted from March 1, 2018, to February 28, 2023. Examination of disease characteristics in three time period cohorts (before, during, and following the COVID-19 pandemic) was undertaken. Timeframes were consistent with implementation and abolition of public health restrictions in the province of Newfoundland and Labrador. Results: A total of 483 surgically managed RCC cases were identified during the study period. The median age was 65 years (interquartile range [IQR] 56–71), and 62.3% of patients were male. Demographics did not vary across timeframes. Before and during the pandemic, pathologic stage 3 (pT3) disease was reported in 38.9% and 35.4% of cases, respectively, whereas the post-pandemic period saw this presentation in 50.0% of patients. Surgical wait times increased significantly across study timeframes (p=0.003). Conclusions: The first year following the COVID-19 pandemic saw an 11.1% increase in patients presenting with pT3 RCC. These findings are suggestive of a clinically significant stage migration, which paired with prolonged wait times for surgery, provide critical consideration in the urgency of diagnostic and treatment decisions for RCC in the immediate future.

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Stage migration of testicular germ cell tumours in Alberta, Canada, during the COVID-19 pandemic: a retrospective cohort study

Cited by 3 publications

References 42 publications

Restricted access and advanced disease in post-pandemic testicular cancer

Restricted access and advanced disease in post-pandemic testicular cancer

Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study

Impacts of the COVID-19 pandemic on diagnosis of renal cell carcinoma and disease stage at presentation

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