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

Abstract

The COVID-19 pandemic threatened to completely change the priorities of our health systems. However, the diagnosis and timely treatment of patients with cancer should never be compromised: the interruption or delay of cancer surveillance or treatments schedules, because of pandemic, may significantly impact patients' survival. 1 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][3][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][6][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. | PATIENTS AND ME THODSThis is a single centre, retrospective study, including patients with HCC managed by our multidisciplinary team. To assess if the modified strategies adopted to manage HCC during the COVID-19 pandemic allowed us to maintain the standard of care, we compared selected KPI in 2020 with those generated in 2019, in patients with HCC discussed in a weekly multidisciplinary team meeting (MDTM).According to the SARS-CoV-2 incidence in Italy, four different periods were compared: the prepandemic phase (January-February), the first-wave phase (March-May), the low-incidence phase (June-September) and the second-wave phase (October-December).

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

“…In an online survey in Asia updated in May 2020, it was reported that there has been a 26.7% decrease in HCC diagnoses compared to the prepandemic period [13]. On the other hand, therapeutic management of patients diagnosed with HCC in the early months of pandemic (2020) appears to have been maintained at an adequate level [14], but although these previous studies have been fundamental, they have significant limitations. Notably, no data were collected to demonstrate whether the COVID-19 pandemic had adverse effects on the stage of HCC at diagnosis.…”

An Unprecedented Challenge: The North Italian Gastroenterologist Response to COVID-19

“…Hospitalizations were longer and characterized by higher mortality compared to the pre-COVID era. Coherently, elective admissions and endoscopic or dedicated interventional radiological procedures decreased, reflecting the cancellation of all deferrable procedures [ 6 , 7 , 8 , 9 ] and the relocation of most gastroenterological resources (beds, facilities, instrumentations, healthcare personnel) to the prevaricating care needs linked to the pandemic. Another aspect highlighted in our study is the importance and efficacy of regular active surveillance of patients and healthcare personnel with nasopharyngeal swabs and the use of second-level single-use PPE.…”

Impact of SARS-CoV-2 Pandemic on the Management of Patients with Hepatocellular Carcinoma

“…Barry et al [ 30 ] proposed different treatment recommendations for every BCLC stage: for early BCLC stages (0-A), they prefer surveillance, ablation with microwaves or radiofrequency, or other bridge locoregional treatment instead of surgical or liver transplant option, while for BCLC B or C, the usual treatment options can be maintained. Iavarone et al, in a single center report, describe measures adopted to prevent SARS-CoV-2 infection in HCC patients [ 31 ]. They managed the admission for HCC treatment as follows: using protective equipment, SARS-CoV-2 tested by nasopharyngeal swabs regularly (every 1–2 weeks), well-defined COVID-19-free areas of the hospital with dedicated healthcare staff, a telephone survey aiming to detect possible contact or COVID-19 infection, and a mandatory SARS-CoV-2 test performed the day before admission for patients.…”

“…They managed the admission for HCC treatment as follows: using protective equipment, SARS-CoV-2 tested by nasopharyngeal swabs regularly (every 1–2 weeks), well-defined COVID-19-free areas of the hospital with dedicated healthcare staff, a telephone survey aiming to detect possible contact or COVID-19 infection, and a mandatory SARS-CoV-2 test performed the day before admission for patients. Whenever possible, they preferred radiofrequency ablation to surgery, without the detrimental consequences for the radiological response of HCC patients [ 31 ]. They demonstrated that these strategies were able to safely ensure continuity of care for patients with HCC.…”

“…Deviations from ‘‘standard’’ treatment should be discussed and validated in an MD tumor meeting. The alternative therapeutic decision, as well as the benefits of the choice and their associated risks, should be discussed with the patient and accurately documented for legal purposes [ 31 ].…”