Major impact of COVID-19 national containment on activities in the French northern comprehensive cancer center

Abstract

The SARS-CoV-2 pandemic has significantly impacted cancer patient management. National and local recommendations to reduce SARS-CoV-2 transmission have been applied in a comprehensive cancer center located in Northern France. We prospectively measured key indicators for three successive eight-week periods: directly before, during, and right after the containment (from 16 March to 10 May 2020). Overall, the number of newly diagnosed and referred cancer patients in our hospital steadily increased (1027; 1135 and then 1704; +11% during containment and +50% just after). To reduce patient transportation, teleconsultations were implemented. Teleconsulting activity steadily increased during the three periods (5, 2025, and 2351). However, a marked decrease in the number of surgical procedures was observed (448; 330 and 288; −26% during containment and −13% just after). We observed a slight decrease in the number of radiation therapy sessions (7761; 7328 and 7075; −6% during containment and −3% just after) and in day-hospital cycles of IV systemic treatment (2891; 2736 and 2717; −5% during containment and −1% just after). We observed an increase in the number of patients admitted to palliative care and a dramatic reduction in clinical trial enrollment. During this 24-week period, organizational changes were mainly characterized by an increase in newly diagnosed cancer patient referral and the implementation of protective measures, such as teleconsultations. Activities in cancer surgery have decreased while radiotherapy and chemotherapy activities were stable.

Trends in cancer imaging by indication, care setting, and hospital type during the COVID‐19 pandemic and recovery at four hospitals in Massachusetts

“… 24 The management of active cancers also experienced a worrisome drop, with both US‐based and international studies finding high rates of cancellations and delays for chemotherapy, radiation therapy, surgeries, and cancer‐related admissions. 10 , 11 , 13 , 14 One study recorded a rise in palliative care enrollment during 2020, which suggests that support for pain and symptom management was available to cancer patients, but also that more individuals might have opted out of anticancer therapies in favor of comfort measures. 11 Importantly, none of these studies conducted investigations past the summer of 2020, and thus lacked the ability to record the longer term effects of the pandemic on cancer care.…”

“… 10 , 11 , 13 , 14 One study recorded a rise in palliative care enrollment during 2020, which suggests that support for pain and symptom management was available to cancer patients, but also that more individuals might have opted out of anticancer therapies in favor of comfort measures. 11 Importantly, none of these studies conducted investigations past the summer of 2020, and thus lacked the ability to record the longer term effects of the pandemic on cancer care. The present study remedies this by analyzing cancer imaging during the pandemic until the end of 2020.…”

“…Another US‐based study recorded decreases in five different modalities of cancer screening (low dose CT, pap test, colonoscopy, prostate‐specific antigen, and mammography) during the COVID‐19 peak, with subsequent declines in ensuing diagnoses 24 10,11,13,14 . One study recorded a rise in palliative care enrollment during 2020, which suggests that support for pain and symptom management was available to cancer patients, but also that more individuals might have opted out of anticancer therapies in favor of comfort measures 11 .…”

“… 10 International studies registered lower numbers of chemotherapy appointments, radiation therapy sessions, and cancer‐related admissions in spring 2020. 11 , 12 , 13 , 14 Finally, cancer screening was severely affected by the pandemic: lung cancer screening decreased by more than 70% between March and May 2020, 15 cervical cancer screenings by 78%, 16 colorectal cancer screenings by 85%, 9 and mammograms by up to 92%. 9 , 17 , 18 …”

“…Another study found outpatient visit volumes in spring 2020 to be lower than 2019 volumes by 60%–70%, and it also uncovered a decline in mastectomies, colectomies, and prostatectomies 10 . International studies registered lower numbers of chemotherapy appointments, radiation therapy sessions, and cancer‐related admissions in spring 2020 11–14 . Finally, cancer screening was severely affected by the pandemic: lung cancer screening decreased by more than 70% between March and May 2020, 15 cervical cancer screenings by 78%, 16 colorectal cancer screenings by 85%, 9 and mammograms by up to 92% 9,17,18 …”