Impact of COVID‐19 pandemic on surveillance of hepatocellular carcinoma: A study in patients with chronic hepatitis C after sustained virologic response

Abstract

Background The current coronavirus disease 2019 (COVID‐19) pandemic has strongly influenced many aspects of the medical care, including cancer surveillance. Aims We investigated how the COVID‐19 pandemic influenced surveillance for hepatocellular carcinoma (HCC), focusing on patients with hepatitis C virus infection who were receiving surveillance for HCC after sustained virologic response (SVR) in Japan. Methods Patients who achieved SVR between 1995 and 2017 and continued receiving surveillance were compared by month in terms of the rate at which they kept their scheduled visits for HCC surveillance from July 2019 to May 2020. Results The percentage of kept scheduled visits was above 97% before February 2020. By contrast, it declined sharply after March 2020 when COVID‐19 became pandemic; the percentages were 75.5% in March, 63.0% in April and 49.1% in May 2020 (July 2019–February 2020 vs March–May 2020, P < 0.0001). Similar declines were observed in patients with cirrhosis or advanced fibrosis and in those with a history of HCC. Whereas most patients who cancelled a scheduled visit before February 2020 did not reschedule it, the majority of patients with cancellations after March 2020 did want to reschedule. Conclusions The percentages of scheduled visits that were kept declined rapidly after COVID‐19 became pandemic in Japan, although the spread of COVID‐19 is relatively mild and the legal restriction of people's behaviour and movement is absent. Instituting measures to follow‐up with cancelled patients and resume surveillance will be necessary in the future.

Impact of COVID-19 pandemic on liver, liver diseases, and liver transplantation programs in intensive care units

“…In patients with hepatitis C virus who were following up for HCC, there was significant reduction in their scheduled visits, i.e. , by before 75%, 63.0%, and 49.1% in March to May 2020, respectively, compared with 97% before February 2020[ 132 ]. Surgical interventions for HCC have significantly declined or stopped across many centers in the world due to increased risk of blood transfusion, ICU stay, prolonged hospitalization and developing COVID-19 after surgery[ 133 ].…”

Reshape and secure HCC managing during COVID‐19 pandemic: A single centre analysis of four periods in 2020 versus 2019

“…This is particularly true for HCC: despite the task of guaranteeing the safety of our patients, facing a new infection with increased mortality risk in patients with cirrhosis, we needed to maintain treatments of HCC and in the adequate timeframe 2‐4 . While studies had shown how deep the pandemic has changed the management of HCC with respect to surveillance, diagnosis and treatment, none has evaluated the effectiveness of the measures taken to cope with COVID‐19 1,5‐7 . To evaluate the impact of new measures deployed for HCC management during the pandemic, we compared the efficiency and clinical quality key performance indicators (KPI) generated from 2020 to 2019.…”

COVID-19 Mid-term Impact on Hepatocellular Carcinoma in Patients With Hepatitis C Chronic Infection

“…DAAs therapy resulted in significantly higher sustained virologic response (SVR) rates in over 95% of the cases, in all HCV genotypes (7). However, successful antiviral therapy does not completely obliterate the risk of HCC occurrence; therefore, it is highly essential that HCC screening never stops in these patients (8,9). Moreover, except for increasing the likelihood of hepatic malignancy, HCV chronic infection is responsible for a large variety of extrahepatic manifestations (including metabolic disorders, extrahepatic malignancies, autoimmune or inflammatory disorders), and therefore, is considered a systemic disease, rather than just a liver condition (4,(10)(11)(12)(13).…”