Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID)

Abstract

Background. The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) – from diagnosis to treatment – of the reorganisation of the health care system during the first lockdown. Methods. This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1 st , 2019 and October 31 st , 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 st to May 11 th , 2020) and after lockdown. Results. During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, -18.2%; p=0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, -1.7%; p=0.97). The number of borderline tumours increased (13.6% to 21.7%) whereas the rate of metastatic diseases rate dropped (47.1% to 40.3%) (p=0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7% to 32.6%) compared with upfront surgery (13% to 7.8%) (p=0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9% to 69%; p=0.044). After lockdown, the number of borderline tumours decreased (21.7% to 9.6%) and advanced diseases increased (59.7% to 69.8%) (p=0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%). Conclusion. This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up.

One‐year COVID‐19 outcomes on the oncology care patient pathway: Results of a French descriptive, cross‐sectional comprehensive study (ONCOCARE‐COV)

“…Neither supportive and palliative care nor clinical research activity were included in our data compilation. However, previously published study did not show any influence of age, gender, or distance between home and health care facility on care delivery during the epidemic 37 . Dedicated studies might better specify the impact of the COVID‐19 pandemic on survival.…”

“…Moreover, imposed therapeutic adjustments such as neoadjuvant treatments in aggressive resectable primary tumors due to delayed surgery were recommended with unknown consequences on prognosis. 37 A drastic shift (April, −29.1% and May, −20.6%) in the number of oncological surgeries performed, interventional radiology (March, −50%; April −44.4%), and cytoreductive surgery with HIPEC (−100%) was observed. These results are consistent with the conclusions from several studies done throughout the world, 38,39 and may worsen the prognosis.…”

“…Moreover, imposed therapeutic adjustments such as neoadjuvant treatments in aggressive resectable primary tumors due to delayed surgery were recommended with unknown consequences on prognosis. 37 …”

“…However, previously published study did not show any influence of age, gender, or distance between home and health care facility on care delivery during the epidemic. 37 Dedicated studies might better specify the impact of the COVID‐19 pandemic on survival. However, predictions show that a substantial proportion of patients with curable tumors will progress to incurable disease.…”

“…Prognosis of patients with aggressive diseases might have been more severely impacted than others due to therapeutic delays and inadequate treatment strategy. Moreover, imposed therapeutic adjustments such as neoadjuvant treatments in aggressive resectable primary tumors due to delayed surgery were recommended with unknown consequences on prognosis 37 …”