COVID-19 pandemic: Impact on the management of patients with hepatocellular carcinoma at a tertiary care hospital

Abstract

Background Patients with hepatocellular carcinoma (HCC) represent a vulnerable population potentially negatively affected by COVID-19-associated reallocation of healthcare resources. Here, we report the impact of COVID-19 on the management of HCC patients in a large tertiary care hospital. Methods We retrospectively analyzed clinical data of HCC patients who presented at the Vienna General Hospital, between 01/DEC/2019 and 30/JUN/2020. We compared patient care before (period 1) and after (period 2) implementation of COVID-19-associated healthcare restrictions on 16/MAR/2020. Results Of 126 patients, majority was male (n = 104, 83%) with a mean age of 66±11 years. Half of patients (n = 57, 45%) had impaired liver function (Child-Pugh stage B/C) and 91 (72%) had intermediate-advanced stage HCC (BCLC B-D). New treatment, was initiated in 68 (54%) patients. Number of new HCC diagnoses did not differ between the two periods (n = 14 vs. 14). While personal visits were reduced, an increase in teleconsultation was observed (period 2). Number of patients with visit delays (n = 31 (30%) vs. n = 10 (10%); p = 0.001) and imaging delays (n = 25 (25%) vs. n = 7 (7%); p = 0.001) was higher in period 2. Accordingly, a reduced number of patients was discussed in interdisciplinary tumor boards (lowest number in April (n = 24), compared to a median number of 57 patients during period 1). Median number of elective/non-elective admissions was not different between the periods. One patient contracted COVID-19 with lethal outcome. Conclusions Changes in patient care included reduced personal contacts but increased telephone visits, and delays in diagnostic procedures. The effects on long-term outcome need to be determined.

Outcome of liver cancer patients with SARS‐CoV‐2 infection: An International, Multicentre, Cohort Study

“…One of the main harms of the pandemic according to Muñoz et al 2 was the delay in liver cancer diagnosis because of the modification of screening, reported in 80.9% of the participating centres. A similar impact of COVID-19 was also reported for other cancers [4][5][6][7] and in the current study, here we characterize the profile and evolution of those patients incidentally diagnosed with liver cancer as a result of the assessments done because of COVID-19 infection diagnosis and those who had a history of liver cancer.…”

Effect of COVID-19 Pandemic on Hepatocellular Carcinoma Diagnosis: Results from a Tertiary Care Center in North-West Italy

“…There was no difference in the number of diagnoses of HCC before and after the lockdown (14 vs. 14). After the lockdown, more patients were delayed in visits and imaging tests, but no information was available on the stage of HCC [20]. In France, a significant decrease in the rate of HCC patients referred for first diagnosis or treatment was observed in the first weeks of the pandemic, but no data on the effect of lockdown after months or years are known [21].…”

COVID-19 and liver disease

“…This has resulted in delayed presentation and hospitalisation of sicker patients with advanced cirrhosis, increased liver-related mortality and a reduction in overall patient satisfaction 59 61. The strain on healthcare resources and prioritisation of social distancing has also led to interrupted HCC surveillance programmes leading to delayed presentation and increased tumour size at diagnosis compared with the pre-pandemic era 62 63…”