The unfavorable effects of COVID‐19 on Dutch advanced melanoma care

Abstract

The COVID‐19 pandemic had a severe impact on medical care. Our study aims to investigate the impact of COVID‐19 on advanced melanoma care in the Netherlands. We selected patients diagnosed with irresectable stage IIIc and IV melanoma during the first and second COVID‐19 wave and compared them with patients diagnosed within the same time frame in 2018 and 2019. Patients were divided into three geographical regions. We investigated baseline characteristics, time from diagnosis until start of systemic therapy and postponement of anti‐PD‐1 courses. During both waves, fewer patients were diagnosed compared to the control groups. During the first wave, time between diagnosis and start of treatment was significantly longer in the southern region compared to other regions (33 vs 9 and 15 days, P ‐value <.05). Anti‐PD‐1 courses were postponed in 20.0% vs 3.0% of patients in the first wave compared to the control period. Significantly more patients had courses postponed in the south during the first wave compared to other regions (34.8% vs 11.5% vs 22.3%, P ‐value <.001). Significantly more patients diagnosed during the second wave had brain metastases and worse performance status compared to the control period. In conclusion, advanced melanoma care in the Netherlands was severely affected by the COVID‐19 pandemic. In the south, the start of systemic treatment for advanced melanoma was more often delayed, and treatment courses were more frequently postponed. During the second wave, patients were diagnosed with poorer patient and tumor characteristics. Longer follow‐up is needed to establish the impact on patient outcomes.

Limited impact of COVID ‐19‐related diagnostic delay on cutaneous melanoma and squamous cell carcinoma tumour characteristics: a nationwide pathology registry analysis

“…A recent study reported a significant delay in immunotherapy treatment of patients with advanced melanoma in the Netherlands. Moreover, a significant increase in brain metastases and worse performance status was found during the second lockdown 24 . While the increase in brain metastases may have resulted from improved screening instead of treatment delay, these results still suggest an unfavourable impact on patients with advanced melanoma care during the pandemic.…”

Impact of the COVID‐19 pandemic on the hospital attendance of patients with primary cervical cancer in Heilongjiang, China

“…It has been reported that radical surgery and adjuvant therapy in patients with early‐stage cervical cancer can significantly increase patient survival, 31 while delayed diagnosis and treatment will affect patient prognosis 32 . Studies have predicted that delays in cancer diagnosis and treatment due to the COVID‐19 pandemic may affect clinical outcomes over the next decade 33 and have suggested that long‐term preventive measures to protect patients from COVID‐19 may increase cancer‐related mortality 34‐36 . Therefore, a series of measures should be taken to ensure cancer screening in public health emergencies, 26,37 such as allocating a sufficient number of healthcare workers; using risk stratification and classification to prioritize screening high‐risk women; using alternative cancer screening methods such as self‐sampling postal testing or establishing rapid diagnostic kits; after a short training period, allowing staff such as general practitioners, midwives or nurses to participate in screening programs.…”

The impact of the COVID‐19 pandemic on the diagnosis and treatment of skin cancers, a mini review

“…In case of definitive SARS‐CoV‐2 infection, it is reasonable to suspend some targeted therapies like BRAF/MEK inhibitors and HHIs as they aggravate the course of SARS‐CoV‐2 infection and affect the outcome 15 . Anti‐PD‐1 courses are usually postponed in the settings of an acute infection due to the probability of COVID‐19 induced cytokine storm 33 . It is advised to delay cancer treatment for a short 2 to 6 weeks period or until clinical improvement 34 .…”