Time intervals in the care pathway to cancer diagnosis during the COVID‐19 pandemic: A large retrospective study from a high‐volume center

Abstract

Despite extensive research on cancer care during the COVID‐19 pandemic, evidence on the impact on prediagnostic time intervals is lacking. To better understand how COVID‐19 changed the pathway to diagnosis of cancer, we examined the length of intervals from symptom onset to diagnosis for 13 common cancer types with known clinical stage over 1‐year nonpandemic period (March 2019 to March 2020; N = 844) and three biannual COVID periods (March 2020 to September 2021; N = 1172). We analyzed the patient interval (from first symptoms to presentation to a physician), the primary care/emergency department interval (from presentation with relevant symptoms to a primary care or emergency department physician to referral to a hospital‐based diagnosis center) and the hospital interval (from referral to diagnosis). Compared to nonpandemic data, there were significant changes across COVID periods. The pandemic mostly impacted patient intervals for cancers diagnosed over the first 6 months after onset in March 2020. Overall median patient intervals were longest in the early COVID period (39 [IQR 22‐64] days) and shortest in the nonpandemic period (20 [IQR 13‐30] days; Kruskal‐Wallis test [ χ 2 ], P < .0001). Differences in clinical stage between periods were relevant, with cancers from the mid‐period (September 2020 to March 2021) showing the most advanced stage. A shift to later stage was plausibly a result of delayed intervals in the early COVID period. Since intervals are eventually relevant to prognosis, our results provide a baseline against which the impact of improvement strategies to minimize the negative outcomes of COVID‐19‐associated cancer delays can be assessed and implemented.

Referral and Prescription Patterns for Female Patients With Urinary Incontinence

“…The COVID-19 pandemic has been shown to negatively affect referral rates to specialty services for a variety of medical and surgical conditions 26–29 . We believe our study is the first to investigate the impact of COVID-19 on PCP referral rates to specialty providers for UI.…”

“…The COVID-19 pandemic has been shown to negatively affect referral rates to specialty services for a variety of medical and surgical conditions. [26][27][28][29] We believe our study is the first to investigate the impact of COVID-19 on PCP referral rates to specialty providers for UI. Although we found no significant reduction in the diagnosis of UI during the pandemic, there was a statistically significant decrease in referrals to specialist physicians.…”

Axillary Treatment Management in Breast Cancer during COVID-19 Pandemic (Association between ACOSOG Z0011 Criteria and OSNA Test)

“…A second evaluation from a large retrospective study from a high-volume centre demonstrated that between the prepandemic period and March 2020 to March 2021, differences in the clinical stage between periods were relevant, with cancers from the mid-period (September 2020 to March 2021) showing the most advanced stage. A shift to a later stage was plausibly a result of delayed intervals in the early COVID period [ 32 ].…”

Did the COVID-19 pandemic delay treatment for localized breast cancer patients? A multicenter study

“…This increase in time, whether due to COVID-related precautions or the load of COVID patients itself, led to delayed surgeries in many countries because of a restricted number of beds available and overburdened clinicians. The increase in lag time to a cancer diagnosis resulted in more advanced tumor stages at presentation during the late-pandemic period compared to the prepandemic period [5][6][7][8]. Delays in cancer diagnosis were associated with expected increased deaths, up to five years after diagnosis, as reported by a UK population-based modelling study [6].…”