Digestive Oncology in the COVID-19 Pandemic Era

Abstract

Introduction: Since the rise of the COVID-19 pandemic there has been widespread concern regarding the possible delay in the diagnosis/treatment of cancer patients. We aimed to assess the impact of the COVID-19 pandemic on the diagnosis, treatment, and outcome of patients with digestive cancer. Methods: This was a retrospective study including patients with an inaugural digestive cancer diagnosis discussed for the first time at our center during the weekly digestive oncology reunion (DOR) meeting. The study group was enlisted from March to August 2020, and a control group was sourced from the equivalent period of 2018. Patients with a previous digestive cancer diagnosis/discussion in the DOR were excluded. The following data were collected: demographics, referral origin, tumor staging, first DOR discussion timing, treatment, and outcome. Results: A total of 235 patients were included: 107 in the study group (65.4% male, mean age 71.59 years); 128 in the control group (54.7% male, mean age 68.16 years). The mean number of clinical discussions per week was higher in 2018 (13.65 vs. 10.67, p = 0.040), without a difference in the mean number of patients discussed for the first time (inaugural diagnosis) between groups (p = 0.670). In the 2020 study group, more patients were referred to DOR from the emergency room (ER), fewer from the outpatient clinic/hospital wards (p < 0.001), and more were referred after urgent surgery (p = 0.022). There was no difference in the mean waiting time from diagnosis to first DOR discussion (p = 0.087). Tumor staging in colorectal, gastric, and esophageal cancer was not significantly different between the groups (p = 0897, p = 0.168, and p = 0.717). More patients in the study group presented with stage IV pancreatic cancer (p = 0.043). There was no difference in the time span from DOR until the beginning of neoadjuvant chemotherapy (p = 0.680) or elective surgery (p = 0.198), or from surgery until adjuvant chemotherapy (p = 0.396). Also, there was no difference in 30-day mortality from the first DOR date between the groups (p = 0.742). Conclusion: During the COVID-19 era there was a reduced number of clinical discussions in the DOR, but the number of debated patients with an inaugural digestive cancer diagnosis was similar. In the study group more patients were referred to DOR from the ER, and were referred after urgent surgery, suggesting a delayed demand for clinical attention. Study group patients were not significantly affected by the pandemic regarding timely DOR discussion, beginning of treatment, or 30-day mortality, reflecting the maintenance of the quality of care for digestive cancer patients.

The Impact of the COVID-19 Epidemic on Diagnosis, Treatment, Concerns, Problems, and Mental Health in Patients with Gastric Cancer

“…Pearson correlation test showed a linear relationship between the number of cancers diagnosed and the number of endoscopies [18]. Many patients have been referred to the emergency room for warning signs [5], indicating a delay in requesting services [2]. There will be a significant decline in endoscopic services and delays in cancer diagnosis and subsequent long-term progression of cancer.…”

“…A total of 22 studies were eligible for the study according to the objectives of the study and were divided into four categories. The effect of COVID-19 epidemic on the diagnosis of gastric cancer [2,4,5,[15][16][17][18][19], treatment and follow-up [1,[20][21][22][23], problems and concerns of patients with gastric cancer [20,21,24,25], and health psychiatry of patients with gastric cancer [1,25,26].…”

“…During the COVID-19 epidemic, the number of screenings for gastric cancer has been decreased [2,4,5,[15][16][17][18][19]27]. In Italy, the number of endoscopies has decreased by 53.6% compared to 2019 [19].…”

“…Some patients have received telephone [15] Italy Fair The diagnosis of gastric cancer in 2020 has decreased by 10% compared to 2018 and 2019 Wheaton [5] The UK Retrospective study Fair During the COVID-19 epidemic, the endoscopic volume decreased by 88% and cancer diagnosis rate decreased by 66%. This reduction depends on the duration and severity of the restrictions Brito [2] Portugal Retrospective study Good In 2020, most patients were referred from the emergency department, indicating a delay in requesting clinical attention Manes [19] Italy Retrospective study Fair The number of rapid endoscopic procedures has decreased by 53.6% compared to 2019 and 2020 One of the reasons for this decrease was the perception of patients and physicians of the risk of COVID-19 Lantinga [17] Netherlands Retrospectively analyzed endoscopies Good By 2020, endoscopy has declined, which gastroscopy has decreased by 57%. During corona virus limitations, the diagnosis of cancer has been significantly reduced.…”

“…In late 2019, a type of pneumonia caused by coronavirus 19 was recognized as a global epidemic with a significant impact on global health [1]. This pandemic caused the death of more than one million people also caused many people suffering and disruption in their lives [2]. Protective behaviors and personal hygiene are effective in preventing the spread of the disease [3].…”