The influence of the COVID‐19 pandemic on lung cancer surgery in Queensland

Abstract

Background: The coronavirus disease-19 (COVID-19) pandemic poses unprecedented challenges to global healthcare. The contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland. Methods: We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR), thoracic database examining all adult lung cancer resections across Queensland from 1/1/2016 to 30/4/2022. We compared the data prior to, and after, the introduction of COVID-restrictions. Results: There were 1207 patients. Mean age at surgery was 66 years and 1115 (92%) lobectomies were performed. We demonstrated a significant delay from time of diagnosis to surgery from 80 to 96 days (P < 0.0005), after introducing COVID-restrictions. The number of surgeries performed per month decreased after the pandemic and has not recovered (P = 0.012). 2022 saw a sharp reduction in cases with 49 surgeries, compared to 71 in 2019 for the same period. Conclusion: Restrictions were associated with a significant increase in pathological upstaging, greatest immediately after the introduction of COVID-restrictions (IRR 1.71, CI 0.93-2.94, P = 0.05). COVID-19 delayed the access to surgery, reduced surgical capacity and consequently resulted in pathological upstaging throughout Queensland.

Unveiling the Effects of the COVID-19 Pandemic on Lung Cancer Surgery

“…However, it is notable that as the pandemic waned, things gradually returned to normal, with early stages enjoying a significant increase in proportions, accounting for 48.9% of T2–T4 stages. This discrepancy between the pandemic and post-pandemic periods has been observed worldwide [ 17 , 18 ]. Kato et al [ 19 ] reported a significant shift in the distribution of stage I diseases during the pandemic, with a notable decrease in stage IA1 cases and a substantial increase in stage IA3 and IB incidences compared to previous years.…”

“…The decrease in the number of surgeries has been reported globally, with a hospital in the US also reporting a decrease of 50.4% compared to the previous period [ 17 ]. Significant differences have been evidenced in Queensland [ 18 ], as well as in countries such as Japan [ 19 ], Sweden [ 20 ], or England [ 21 ], where a significant decline in the number of surgical interventions performed has also been reported.…”

“…This observation is encouraging and suggests an effective adaptation of the medical system to the conditions imposed by the pandemic. With the lifting of restrictions and a significant reduction in the number of positive COVID-19 cases, screening programs and surgical interventions have resumed their normal course, with a study from Australia showing an increase of over 170% in the number of surgical interventions for lung cancer following the lifting of restrictions [ 18 ].…”

“…These results are consistent with the literature, where in most studies, these variables did not significantly change throughout the pandemic [ 17 , 19 , 24 , 27 , 28 , 29 , 30 ]. However, Kirk et al [ 18 ] identified that patients undergoing surgery during the pandemic exhibited significantly higher ages ( p = 0.006) compared to the pre-pandemic period.…”

“…This study shows a significant decrease both in the total duration of hospitalization ( p = 0.015) and in the pre-operative hospitalization duration (0.006). In a study from Japan [ 19 ], the mean hospitalization duration was 6 days, without a significant change compared to the pre-pandemic period; but in Australia, a significant decrease in both pre-operative and post-operative hospitalization duration was reported [ 18 ]. Hospitals in Europe significantly reduced the duration of hospitalization during the pandemic [ 21 , 25 ], and those in the US followed the same trend [ 36 ].…”