The impact of the COVID‐19 pandemic on the short‐term survival of patients with cancer in Northern Portugal

Abstract

The COVID‐19 pandemic led to potential delays in diagnosis and treatment of cancer patients, which may negatively affect the prognosis of these patients. Our study aimed to quantify the impact of COVID‐19 on the short‐term survival of cancer patients by comparing a period of 4 months after the outbreak began (2 March 2020) with an equal period from 2019. All cancer cases of the esophagus, stomach, colon and rectum, pancreas, lung, skin‐melanoma, breast, cervix, and prostate, from the Portuguese Oncology Institute of Porto (IPO‐Porto) and diagnosed between 2 March and 1 July of 2019 (before COVID‐19) and 2020 (after COVID‐19) were identified. Information regarding sociodemographic, clinical and treatment characteristics were collected from the cancer registry database and clinical files. Vital status was assessed to 31 October of the respective years. Cox proportional hazards regression was used to estimate crude and propensity score‐adjusted hazards ratio (HR) and 95% confidence intervals (95% CIs) of death. During follow‐up to 31 October, there were 154 (11.8%) deaths observed before COVID‐19 and 131 (17.2%) after COVID‐19, corresponding to crude and adjusted HRs (95% CI) of 1.51 (1.20‐1.91) and 1.10 (0.86‐1.40), respectively. Significantly higher adjusted hazards of death were observed for patients with Stage III cancer (HR = 2.37; 95% CI: 1.14‐4.94) and those undergoing surgical treatment (HR = 3.97; 95% CI: 1.14‐13.77) or receiving radiotherapy (HR = 1.96; 95% CI: 1.96‐3.74), while patients who did not receive any treatment had a lower mortality hazards (HR = 0.62; 95% CI: 0.46‐0.83). The higher overall short‐term mortality observed during the COVID‐19 pandemic largely reflects the effects of the epidemic on the case‐mix of patients being diagnosed with cancer.

Impact of COVID-19 pandemic on diagnostic pathology in the Netherlands

“…The decline in resected malignancies from lower gastrointestinal tract, female genital tract and breast after period 1 might not only reflect a lower number of cancer diagnoses. It might be that a choice for other (neoadjuvant) treatment modalities like radiotherapy and/or chemotherapy was made more frequently under the given circumstances, thus postponing surgery and putting less strain on intensive care facilities [ 2 , 21 – 23 ]. However, a catch-up in numbers is not seen.…”

The effect of Covid-19 pandemic on gastric cancer surgery

“…Lui et al [9] concluded that the time to surgery did not impact overall survival or disease-free survival, but a time to surgery over six weeks improved the pathological complete response. However, Moraiset al [10] reported a higher short-term mortality rate in the patient group with mostly gastrointestinal cancer cases.…”

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review

“…With respect to mortality in cancer patients, 24 indicators were identified from 4 articles. Twenty of these indicators resulted from one Portuguese study [105], the other 3 indicators showed a stable postoperative death rate in patients with head and neck cancer (France) [102], and a stable in-hospital mortality rate for orthopedic tumors at the traumatology department (Germany) [123]. One Turkish study [100] documented increased mortality in occlusive colorectal cancers patients.…”